RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX		CASE: PD-2017-02434 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20080208

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E4, Financial Management Technician, medically separated for “bilateral knee and shin pain,” rated 10% each, with a combined disability rating of 20%.

CI CONTENTION:  “Review all conditions.”  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 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 - 20090217	VARD - 20081218	
Condition	Code	Rating	Condition	Code	Rating	Exam	

Bilateral Knee and Shin Pain	5299-
5257	10%
+10%	Bilateral Patellofemoral Syndrome	5099-
5014	0%	20081112	
			Residuals, Bilateral Stress Fractures	5299-
5262	NSC	20081112	
Right Side Sciatica	Not Unfitting	Meralgia Paresthesia, Right	8729	0%	20081112	
Migraine Headaches	Not Unfitting	Episodic Migraines	8100	10%	20081112	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

Bilateral Knee and Shin Pain. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s bilateral knee and shin condition began in January 2004 when he sustained stress fractures and stress on his knees and shins. The 16 October 2007 MEB NARSUM examination, 4 months prior to separation, noted complaints of bilateral knee, shin, and ankle pain. Physical examination showed knee range of motion (ROM) was 0-140 degrees (normal) with bilateral tenderness below the knee caps and the patellar tendons bilaterally. Mild right midshaft tibial tenderness was not present on the left. There was mild ankle tenderness. Bilateral ankle ROMs were normal. X-rays of the bilateral knees, bilateral tibia-fibulas and left ankle were within normal limits except for some very mild degenerative changes noted in the knees.
At the 12 November 2008 VA Compensation and Pension (C&P) examination, 9 months after

separation, the CI reported bilateral knee pain, stiffness and weakness, and use of a brace and orthotics. Physical examination showed a normal gait. Bilateral knee ROM was 0-140 degrees and bilateral ankle ROM was normal with no evidence of painful motion and no additional loss of motion on repetitive use for either knee or ankle. X-rays of-the knees showed-possible left knee joint effusion without bony abnormality and no arthritic changes. Bilateral tibia-fibula imaging was normal with no acute fractures.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the bilateral knee and shin condition a combined 20%, analogously coded 5257 (knee, other impairment), citing a 10% rating for each knee is provided for minor functional loss caused by pain from repeated use or flare-ups. The VA rated the bilateral knee condition 0%, analogously coded 5014 (osteomalacia), citing no evidence of painful or limited motion, and analogously coded 5262 (tibia and fibula, impairment) the bilateral stress fractures as not service-connected, but denied rating citing no evidence of significant pathology associated with bilateral stress fractures; based on the VA treatment notes and the C&P examination. There was insufficient evidence of tibia and fibula impairment (5262) greater than minimal (not reaching the 10% slight disability) for either leg. The panel considered separately rating each knee separate from each shin. However, evidence did not support any separate or combined compensable rating for either lower extremity greater than the 10% adjudicated by the PEB for either leg IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited). The panel considered other VASRD knee and analogous codes, but all were less applicable and/or not advantageous for rating. There was therefore no VASRD §4.71a rating higher than the 10% for each knee and shin condition adjudicated by the PEB under any applicable code. After due deliberation, considering all 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 and shin condition.

Contended PEB Conditions: Right Side Sciatica and Migraine Headaches. The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting. Both conditions were profiled and implicated in the commander’s statement. Neither condition failed retention standards. There was no performance-based evidence from the record that the conditions significantly interfered with satisfactory duty performance at separation. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended conditions, so no additional disability ratings are recommended.

BOARD FINDINGS: In the matter of the bilateral knee and shin condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the contended right side sciatica and migraine headache conditions, the panel recommends no change from the PEB determination as not unfitting. 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 20170418, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

PD-2017-02434 

AR20190015506, XXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXX

	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