RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03234
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080815

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Combat Engineer, medically separated for “chronic bilateral knee pain,” rated 10% for each side, with a combined disability rating of 20%.

CI CONTENTION:  An additional unfitting condition was not considered.  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 - 20080708	VARD - 20090317	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Knee Pain, Right Knee	5099-5003	10%	Right Knee Patellofemoral Syndrome	5299-5260	10%	20081010	
Chronic Bilateral Knee Pain, Left Knee	5099-5003	10%	Left Knee Patellofemoral Syndrome	5299-5260	10%	20081010	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20% 	

ANALYSIS SUMMARY:

Chronic Bilateral Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s bilateral knee condition began in August 2007 without specific injury.  On September 2001, X-rays showed a small effusion in the left knee joint.  A follow-up bone scan in October 2007 documented increased bilateral medial tibial plateau uptake, but MRI findings were negative.  Conservative therapy was not effective.

The 5 June 2008 MEB NARSUM examination, 2 months prior to separation, noted CI complaints of bilateral knee pain.  Physical examination from 25 April 2008, 4 months prior to separation, showed the CI used partial weight-bearing crutches.  There was bilateral retropatellar grind, pain on compression, but no knee instability or incoordination.  Bilateral knee range of motion (ROM) was 0-140 degrees (normal), with pain, but no loss of ROM with repetition. 

At the 10 October 2008 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported bilateral knee discomfort.  After repetition, left knee ROM was 0-100 and right knee ROM was 0-95 degrees, both with painful motion; X-rays were normal.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left and right knee conditions 10% each, analogously coded 5099-5003 (arthritis, degenerative), citing painful motion.  The VA also rated each knee condition 10%, analogously coded 5299-5260 (leg, limitation of flexion), based on the C&P examination, citing objective pain causing functional impairment for each knee.  Members determined that the objective findings and associated knee disabilities were identical, and agreed with the PEB and the VA that the respective ratings should also be the same.  While there was no limitation of motion which supported a rating for either knee under the diagnostic codes for flexion or extension (5260, 5261), there was sufficient evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) for each knee as adjudicated by the PEB.  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.  Additionally, 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).  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 right and left knee conditions.

BOARD FINDINGS:  In the matter of the chronic bilateral knee pain condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudications.  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 20170311, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180009126, 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