RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01838
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20050325

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Air Traffic Control Operator, medically separated for “bilateral osteoarthritis of the knees” with a disability rating of 20%.   

CI CONTENTION:  The CI contends that not all factors regarding the rating were taken into consideration.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the Medical Evaluation Board (MEB), but determined by the PEB to be not unfitting or non-compensable.  Any conditions outside the panel’s defined scope of review, and any contention not requested in this application, may remain eligible for future consideration by the Board for Correction of Military Records.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for the unfitting medical condition(s) at the time of separation.  The panel has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions; that role and authority is granted by Congress to the Department of Veterans Affairs, which operates under a different set of laws.  The panel gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20050113	VARD - 20060213	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Osteoarthritis of the Knees	5003	20%	Left Knee Osteoarthritis	5299-5003	10%	20051031	
			Right Knee Osteoarthritis	5299-5003	10%	20051031	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Bilateral Osteoarthritis of the Knees.  According to the service treatment record and MEB narrative summary (NARSUM), the CI had knee surgeries in 1993, 1998 and 2000, before entering the military.  After entering the Army his bilateral knee osteoarthritis became symptomatic while running in September 2003.  Radiographic studies revealed bilateral osteoarthritis of the knees.  There was no further surgical indication.  At the time of the family practice clinic appointment on 16 June 2004, 9 months prior to separation, the examiner recorded the CI was having worsening knee pain.  On examination there was no effusion.  Bilateral knee range of motion (ROM) was measured as normal extension and 130 degrees of flexion (normal 140).  At the time of the orthopedic clinic appointment on 24 July 2004, 8 months prior to separation, the examiner recorded the CI could not run at all.  On examination there was bilateral knee tenderness.  ROM was measured as normal extension and flexion to 135 degrees. 

The 4 October 2004 MEB NARSUM examination, 6 months prior to separation, noted complaints of increased knee pain when performing physical training and running.  Physical examination revealed an antalgic gait. There was moderate swelling and joint line tenderness present in both knees. The knee ROM measurements were documented in an unconventional manner which were uninterpretable by this panel; therefore, the recorded numerical values of ROM (in this examination) were not cited nor considered for rating impairment.  Despite such unconventional documentation, the examiner did note that the CI was able to squat to 60 degrees with pain upon movement.  Clinical tests to determine instability were negative.  

At the 31 October 2005 VA Compensation and Pension (C&P) evaluation, 7 months after separation, the CI reported constant bilateral knee pain.   The CI denied any knee dislocations.  He was working as a corrections officer which involved walking, responding to alarms and running (which hurt his knees).  However, he noted his knees did not limit his job performance.  His examination noted bilateral ROM measurements as normal extension and flexion to 125 degrees.  Repetitive movements did not cause any additional loss of motion.  Tests for instability were negative.   

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left and right knee conditions 10% each, coded 5003 (degenerative arthritis), citing occasional incapacitating episode of pain.  The PEB also described the present rating as 20% with an underdetermined EPTS (existed prior to service) factor.  The VA rated each knee at 10% under the analogous 5003 code, based on the C&P examination, citing painful or limited motion of a major joint or group of minor joints.  

Panel members agreed that the objective findings and associated disability for each knee were identical, and agreed with the PEB and the VA that the respective ratings should therefore be the same.  The panel concluded that there was sufficient evidence of painful motion and functional loss to support a 10% rating for each knee IAW §4.59 and §4.40.  In considering higher ratings however, there was no limitation of motion which attained a minimum rating under the diagnostic codes for limitation of flexion (5260) or extension (5261).  There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) or history of surgery to remove a meniscus (5259) to support a rating under those codes.  There was no fracture, nonunion or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  There was therefore no VASRD §4.71a rating higher than the 10% adjudicated by the PEB under any applicable code.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the bilateral knee condition.  

BOARD FINDINGS:  In the matter of the bilateral knee condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination. 

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170303, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180005423, XXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					      
Enclosure