RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04172
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080816

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Firefighter, medically separated for “chronic bilateral knee pain” with a 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 - 20080609	VARD - 20090206	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Knee Pain	5099-5003	10%	Right Knee Sprain	5260-5024	10%	20080922	
		10%	Left Knee Sprain	5260-5024	10%	20080922	
Depressive Disorder NOS	Not Unfitting	Bipolar Disorder 	9432	10%	20080922	
Keratorderna  with Hyperkeratosis	Not Unfitting	No VA Placement	
Insomnia	Not Unfitting	No VA Placement	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

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 November 2003 after he felt a pop in the left knee while running.  He was diagnosed with a meniscal injury to the left knee.  In February 2005, the CI was diagnosed with a right knee sprain and underwent right knee arthroscopy to repair a meniscal tear of the medial meniscus in May 2005.  In October 2007, an MRI of the left knee showed a small joint effusion and slight degenerative meniscal cartilage and the right knee showed a small joint effusion and a horizontal defect along the posterior horn of the meniscus thought to be a horizontal tear.  In May 2008, Ilio-tibial band syndrome and degenerative changes were noted.  

During the 11 March 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, physical examination showed marked pain with any movement especially in excess of 90 degrees of flexion.  Drawer and Lachman’s tests were negative for instability and right knee showed marked crepitus.  The 28 May 2008 MEB NARSUM examination, 3 months prior to separation, noted complaints of daily knee pain.  Pain intensity was reported at 7/10.  Physical examination showed normal knees with no swelling, effusion, erythema or warmth.  Both knees showed tenderness along the lateral joint line, medial joint line and infrapatellar tendon, but no ligamentous laxity or instability.  Range of motion (ROM) testing showed pain limited bilateral flexion at 110 degrees (normal 140) and extension of -2 degrees (normal 0).  Gait was mildly antalgic on the right.  Knee weakness of 4/5 was observed bilaterally secondary to pain.  

At the 22 September 2008 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported stiffness, give way, fatigability and constant pain brought on by physical activity.  Physical examination of both knees showed no edema, effusion, weakness, tenderness, redness, heat, subluxation, locking pain or crepitus.  ROM testing showed flexion of both knees at 140 degrees and extension at 0 degrees.  Pain was noted with flexion of both knees, but motor strength and reflexes were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated each knee 10%, analogously coded 5099-5003 (arthritis, degenerative) citing painful limitation of motion.  The VA rated the right and left knee conditions 10% each, dual coded 5260-5024 (leg, limitation of flexion-tenosynovitis), based on the C&P examination, citing painful motion.  

There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261) for either knee.  However, there was evidence of painful motion with functional loss supporting a 10% rating based on §4.59, §4.40 and §4.45 for each knee.  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to either knee, to support a rating under the respective codes.  There was no fracture, non-union, or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262) to either leg.  There was therefore no VASRD §4.71a rating higher than 10% for either knee as adjudicated by the PEB under any applicable code, and no grounds for additional rating based on the presence of instability.  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.  

Contended PEB Condition:  Depressive Disorder.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  Although the depressive disorder was profiled S2 and implicated in the commander’s statement, it was not judged to fail retention standards.  The depressive disorder was in partial remission, manifested by six months of depressed mood, irritability, anxiety, decreased appetite and insomnia.  Military duty impairment was mild.  Impairment for social and industrial adaptability was also mild and the MEB NARSUM indicated the condition met retention standards.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the depressive disorder, so no additional disability rating is recommended.  

Contended PEB Conditions:  Keratoderma and Insomnia.  There was no performance-based evidence from the record that either of these 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 either of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the bilateral knee condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended depressive disorder, keratoderma and insomnia, the panel recommends no change from the PEB determinations 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:  

AR20190007061, 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.