RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02913
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061024

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Basic Trainee, medically separated for “chronic bilateral knee pain” with a disability rating of 0%.  

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’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 - 20061011	VARD - 20070605	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Knee Pain 	5099 5003 	0%	Left Knee Patellofemoral Pain Syndrome	5024-5260	0%	20070314	
			Right Knee Patellofemoral Pain Syndrome 	5024-5260	0%	20070314	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:  

Chronic Bilateral Knee Pain.  The PEB combined the left and right knee conditions under a single disability rating, coded analogously to 5003 and rated 0%.  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 (STR) and MEB narrative summary (NARSUM), the CI’s bilateral knee condition began in basic training after running and marching.  The pain was relieved by rest but persisted with activity despite physical therapy (PT).  The 3 August 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints of bilateral knee pain.  The physical examination (PE) revealed full active range of motion (ROM) of both knees.  Tenderness without swelling or obvious deformity was present about both kneecaps.  There was no crepitus, joint line tenderness or joint instability noted.  Four days after the NARSUM, PT measured painful but near normal ROM of both knees.  

An orthopedic MEB review conducted on 21 September 2006, 1 month prior to separation, revealed bilateral kneecap tenderness and crepitus.  Other physical parameters to include spasms, subluxation, laxity and or deformity were not in evidence.  There was no comment with regards to painful motion.  X-rays of both knees were normal.  

At the 14 March 2007 VA Compensation and Pension (C&P) evaluation, 5 months after separation, the CI reported bilateral knee pain.  Her PE revealed a normal gait and the ability to heel-to-toe walk.  Bilateral knee ROM was normal and non-painful.  Both knee joints were stable.  

As noted above, the PEB bundled the left and right knee conditions and applied a single 0% rating coded 5099-5003 (arthritis, degenerative), citing no loss of joint motion or evidence of instability.  The VA separately rated each knee condition 0% dual coded 5024-5260 (tenosynovitis-leg, limitation of flexion) based on the C&P examination, citing normal ROM without evidence of knee laxity or instability.  Both knees were profiled and considered to fail retention standards.  The STR evidence did not provide any information which would permit panel members to discriminate the performance limitations attributable to one knee over the other.  Since undue speculation would be required to conclude that impairment from either knee would not have unacceptably interfered with duty performance, members agreed that each knee was reasonably justified as separately unfitting.  The panel then considered its rating recommendation for each knee condition near the time of separation.  

There was no limitation of flexion or extension for either knee that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  There also 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) for either knee 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) for either leg.  Although painful motion (VASRD §4.59) was singularly documented nearly 3 months prior to separation, the preponderance of evidence from other examinations contained within the STR noted tenderness and or crepitus about the knees without painful motion.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded the mere persistence of tenderness and crepitus about the kneecaps would not support any positive degree of impairment.  Therefore, there was insufficient cause to recommend a change in the PEB’s 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 20170213, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180015194, 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.