RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02520
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070811

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Cavalry Scout, medically separated for “chronic bilateral knee pain” with a disability rating of 10%.  

CI CONTENTION:  No specific contention was made.  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 - 20070604	VARD - 20080130	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Knee Pain	5099-5003	10%	Degenerative Joint Disease, Left Knee	5260-5010	10%	20071203	
			Degenerative Joint Disease, Right Knee	5260-5010	10%	20071203	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Bilateral Knee Pain.  The PEB combined the right and left knee conditions as a single unfitting condition coded analogously to 5099-5003 (degenerative arthritis) and rated 10%.  The approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  The panel also noted that “bundling,” the combining of two or more major joints, may be permissible under the VASRD 5003 rating requirements, and that this approach does not compromise the VASRD §4.7 directive to choose the higher of two valid ratings.  The panel’s initial charge in this case was therefore directed at determining if the PEB’s approach of combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  

According to the service treatment record and MEB narrative summary (NARSUM), the CI’s chronic bilateral knee pain began in 2006 following physical training, but with no specific injury.  In October 2006, X-rays revealed bilateral osteochondral defects (OCD) on the lateral femoral condyles (cartilage and bone damage below the femur).  The CI underwent a left knee arthroscopy in January 2007 which showed a healing OCD without evidence of loose fragments.  

During the 8 May 2007 MEB NARSUM examination, 3 months prior to separation, the CI reported bilateral knee pain that limited his activities, with clicking and instability while running.  Physical examination showed no bilateral knee tenderness, laxity, instability, weakness, or lower extremity sensory deficit.  Bilateral knee extension was 0 degrees (normal) and flexion was 135 degrees (normal 140) with crepitus; painful motion was not addressed.  

At the 14 September 2007 VA primary care examination, 1 month after separation, the CI complained of bilateral knee pain, and the provider noted a normal gait, joints and strength. The 30 January 2008 VA Rating Decision indicated continued reports of chronic bilateral knee pain with X-rays documenting bilateral degenerative knee changes.  Range of motion (ROM) measurements revealed bilateral knee extension to 0 degrees and flexion to 130 degrees, without pain.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral knee condition 10%, as noted above, citing degenerative joint disease of two or more major joints with radiographic evidence and no loss of motion.  The VA rated the right and left knee conditions 10% each, dual coded 5260-5010 (leg, limitation of flexion-degenerative arthritis), based on the C&P examination, citing X-ray evidence of degenerative changes.  Members first considered whether each knee condition remained separately unfitting, having been decoupled from the combined PEB adjudication.  Both knees were permanently profiled, implicated as duty limiting in the commander’s statement and MEB NARSUM, and failed retention standards.  Thus, the panel agreed that each knee was reasonably justified as separately unfitting.  

Members noted there was no limitation of flexion or extension (5260 or 5261), or evidence of painful motion with functional loss to support 10% ratings for either knee (based on §4.59, §4.40 and §4.45).  Additionally, there was no meniscal surgery (5259), evidence of dislocated meniscus or loss body causing frequent locking with recurrent effusions (5258), or fracture, nonunion or malunion of the femur or tibia causing a knee impairment (5255, 5262) to support a rating for either knee under those codes.  However, there was objective X-ray evidence of degenerative changes (arthritis) in both knees to support a bilateral 10% rating based on 2 or more major joints IAW code 5003 criteria.  There was no evidence of occasional incapacitating exacerbations to support the next 20% rating.  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 chronic bilateral knee pain condition.

BOARD FINDINGS:  In the matter of the chronic bilateral knee pain and IAW VASRD §4.71, 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 20170315, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20190006038, 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.