[AR Number], XXXXXXXXXX

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

XXXXXXXXXX:

	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.

				      
Enclosure

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX 	CASE:  PD-2017-03253
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080606

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Automated Logistical Specialist, medically separated for “bilateral knee 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’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 – 20080328	VARD - 20081118	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Knee Pain	5099-5003	10%	Right Knee Plica Syndrome	5299-5261	10%	20081025	
		10%	Left Knee Patellofemoral Syndrome	5299-5261	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Bilateral Knee Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI experienced chronic atraumatic bilateral knee pain for approximately 3 years.  Radiographic studies of the knees in January 2008 showed a right knee osteochondral injury and a normal left knee.  Goniometric range of motion (ROM) testing by physical therapy on 5 February 2008 showed pain- limited right knee flexion of 115 degrees (normal 140) and pain-limited left knee flexion of 126 degrees.  Right and left knee extension was 0 degrees (normal).  The 21 February 2008 MEB NARSUM examination, 4 months prior to separation, noted complaints of chronic knee pain.  Physical examination showed tenderness over the medial femoral condyle bilaterally.  

At the 25 October 20008 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported knee pain worsening in airborne school.  Physical examination revealed an antalgic gait favoring the right lower extremity.  There was tenderness along the lateral aspect of each patella.  There was a palpable click with extension of the left knee.  The ROM study showed bilateral flexion of 130 degrees and bilateral extension of 0 degrees.  There was no loss of motion after repetition and painful motion was reported.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right and left knee conditions 10% each, analogously coded 5099-5003 (arthritis, degenerative), citing evidence of painful motion of each knee.  The VA also rated the right and left knee conditions 10% each, analogously coded 5299-5261 (leg, limitation of extension), based on the C&P examination, citing pain with motion on each knee.  

There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261) for either knee.  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 for either knee.  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.  However, there was evidence of painful motion with functional loss supporting a 10% rating for each knee (based on §§4.59, 4.40 and 4.45).  There was therefore no VASRD §4.71a rating higher than the 20% adjudicated by the PEB for the bilateral knee condition 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 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: