RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX.  	CASE:  PD-2017-04594
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080220

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

CI CONTENTION:  “My knees and shoulders is why I was put out of the military.”  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 - 20090305	VARD - 20081002	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Knee Pain	5099-5003	10%	Right Knee Chronic Strain	5099-5019	10%	20080505	
		10%	Left Knee Pain	5299-5260	NSC	20080505	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Bilateral Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI had a long history of non-traumatic bilateral knee pain which became progressively worse, right greater than left, and was ultimately diagnosed as patellofemoral pain syndrome.  An MRI of the right knee was normal and there was no surgical indication.  During the 29 August 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported right knee pain and swelling after prolonged standing, walking or exercising.  Physical examination revealed right knee joint line pain with patellar grind and tenderness.  There were no comments regarding the left knee.  
	
The 28 September 2007 MEB NARSUM examination, 5 months prior to separation, noted complaints of right greater than left knee pain which worsened with running, jumping or prolonged sitting.   Physical examination showed an antalgic gait primarily protecting the right knee.   The bilateral knee range of motion (ROM) measurements were flexion of 140 degrees (normal) and extension of 0 degrees (normal), with pain at endpoint of flexion bilaterally.

At the 5 May 2008 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported right greater than left knee pain.  X-rays of both knees were normal.  Physical examination showed a slight limp on the right; there was no effusion.  There was slight loss of patellar movement with some crepitus felt under the patella.  Bilateral knee ROM was flexion of 140 degrees and extension of 0 degrees without painful motion.  The examiner diagnosed right knee chronic strain with chondromalacia and stated the left knee examination was normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated each knee condition 10% with a combined rating of 20%, analogously coded 5099-5003 (arthritis, degenerative), citing minor functional loss caused by pain from repeated use or flare-ups.  The VA rated the right knee condition 10%, analogously coded 5099-5019 (bursitis), based on the C&P examination, citing painful or limited motion of a major joint.  The VA determined the left knee condition was not service-connected.  

There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261). 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. 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). 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.  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 bilateral knee condition.  

BOARD FINDINGS:  In the matter of the right knee condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the left knee condition and IAW VASRD §4.71a, the panel unanimously 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:

AR20190000586, XXXXXXXXXX

Dear 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.