RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2017-05131
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20040222

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Preventive Medicine Specialist, medically separated for “bilateral knee pain” with a disability rating of 0%.  

CI CONTENTION:  No specific contention was made.  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 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 - 20031124	VARD - 20040712	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Knee Pain	5099-5003	0%	Right Knee Medial Retinacular Strain	5014	10%	20040519	
			Left Knee Medial Retinacular Strain	5014	10%	20040519	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Bilateral Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI experienced bilateral knee pain associated with running, and on 11 September 2002, she was diagnosed with patellofemoral syndrome; bilateral knee X-rays in November 2002 were normal.  According to the commander’s statement on 29 September 2003, the bilateral knee pain made it difficult to perform military specialty duties and maintain physical fitness requirements.  Both knees were profiled on 30 September 2003 with restrictions on prolonged standing, rucking and jumping.  The CI was unable to perform the physical fitness test.  

During the 17 October 2003 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported bilateral knee pain, and the examiner noted bilateral knee tenderness with crepitus and positive grinding on the right.  There was no laxity, and Lachman’s and McMurray’s signs were negative for instability.  Range of motion (ROM) was from 0-142 degrees in both knees.  At the 28 October 2003 orthopedic consult, the CI complained of ongoing knee pain and minimal improvement with physical therapy, profiles and anti-inflammatory medications.  The examiner recorded positive grind and apprehension tests, but no atrophy or effusion, and “full range of motion in both her knees 0-130 degrees” with no comment regarding painful motion.  The 5 November 2003 MEB NARSUM examination noted reports of daily knee pain that developed after a few hours of activity, and was worsened by standing/walking more than 15 minutes, or running squatting, stooping or crawling.  

The 19 May 2004 VA Compensation and Pension (C&P) examination, performed 3 months after separation was not found in evidence, but the VA rating decision provided examination details.  The CI reported pain in both knees since 2002 with no significant improvement from conservative treatment.  Physical findings showed no instability or crepitus, and normal motor testing.  Bilateral knee ROM was from 0-135 degrees, with mild retinacular pain on both sides.  There was painless arc of motion on the right and joint line tenderness on the left, with no additional comment on painful motion of the left knee.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB bundled the right and left knee conditions and applied a single 0% rating coded 5099-5003.  The VA rated each knee 10%, each coded 5014 (osteomalacia), based on the C&P examination, citing painful or limited motion of a major joint or group of minor joints.  Panel members first considered whether either knee, having been de-coupled from the combined PEB adjudication, remained separately unfitting.  In this case, both knees were profiled and implicated by the NARSUM and commander’s statement, and both failed retention standards.  The commander’s statement and other STR evidence did not provide any information which would permit the panel to discriminate the performance limitations attributable to either knee over the other.  Since undue speculation would be required to conclude that impairment from either knee would not have unacceptably interfered with the performance of military duties, the panel agreed that each knee was reasonably justified as separately unfitting.  However, there was no objective evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) for either knee, and after considering other VASRD knee and analogous codes, panel members agreed that all were less applicable and/or not advantageous for rating.  A bilateral (combined) 10% rating under the code 5003 was considered, but there was no X-ray evidence of degenerative arthritis involvement in either joint.  There was therefore no evidence to support a rating higher than 0% for either knee.  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.  

PD-2017-05131

XXXXXXXXXXXXXXXXXXX 

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

PD-2017-05131