RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXX	CASE: PD-2017-05201
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20061010

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, M1 Armor Crewman, medically separated for “chronic bilateral knee pain” with a disability rating of 0%.

CI CONTENTION:	“Requesting  PDBR  review  for  recharacterization  of  separation to medical retirement.”  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 - 20060705	VARD - 20070623	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Knee Pain	5099-5003	0%	Chondromalacia Patella Left Knee	“8099”-5024	10%	STR	
			Chondromalacia Patella Right Knee	5099-5024	10%	STR	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 20%	
	
ANALYSIS SUMMARY:

Chronic Bilateral Knee Pain. The PEB combined the right and left knee conditions under a single disability rating, coded analogously to 5003 (degenerative arthritis) and rated 0%. This approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications. The panel noted that “bundling,” the combining of two or more major joints, may be permissible under the VASRD 5003 rating requirements, and that this approach does not compromise the VASRD §4.7 directive to choose the higher of two valid ratings.      The panel’s initial charge in this case was therefore

directed at determining if combining conditions under a single rating was justified in lieu of separate ratings. When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability. When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that adjudicated by the PEB. The evidence for the bilateral knee condition is presented together, with attendant recommendations regarding separate unfitness, and separate rating if indicated.

According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s right knee condition began in November 2001 after running and became worse while playing volleyball in Iraq. Bilateral knee X-rays from August 2003 were normal. A right knee MRI in April and September 2004 showed degenerative changes (mild diffused chondral cartilage loss in the medial compartment; there was also possible bone bruising with medial collateral ligament [MCL] injury suggested.  Orthopedic diagnosis was chronic MCL sprain.

The 30 November 2004 family health examination, 22 months prior to separation, noted complaints of right knee pain. Physical examination revealed right knee tenderness and pain with full right knee flexion. Knee range of motion (ROM) and a left knee examination were not addressed. The 4 January 2005 family health examination, 16 months prior to separation, noted complaints of chronic right knee pain. Right knee pain and symptoms were progressive with near constant pain that interfered with sleep. Physical examination showed a slight limp. Knee ROM and a left knee examination were not addressed.

During the 17 April 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported “chronic bilateral knee pain in my right knee.” Physical examination revealed no right knee effusion or laxity. “Full” right knee ROM was not quantified. The left knee was not addressed. The 14 June 2006 MEB NARSUM examination, 4 months prior to separation, noted complaints of bilateral knee pain. Pain was present 80% of the time and increased in intensity if he sat for 30 minutes, stood for 10 minutes, walked for about an hour, or climbed and bent the knees. Physical examination showed bilateral knee tenderness, right greater than left, and negative patellar and meniscus testing. Bilateral knee ROM was “normal.” Painful motion was not addressed. Bilateral leg, ankle, foot, toes, and posture were without significant abnormality. Right and left knee X-rays performed in May 2006 were normal and there was no surgical indication.  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the bilateral knee condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing no limitation of motion. The VA rated each knee condition 10%, analogously coded 5099- 5024 (tenosynovitis), based on the STR, citing painful or limited motion of a major joint or group of minor joints. The panel first considered if the bilateral knees, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above. The bilateral knees were profiled, implicated by the MEB NARSUM and the commander’s statement, and failed retention standards. The panel agreed that undue speculation would have to be applied to conclude that impairment from either knee would not have interfered with the CI’s military performance; therefore, each knee is reasonably justified as separately unfitting. Panel members agreed that the right knee MRI revealed degenerative changes while the left knee had no abnormal diagnostic imaging. There was no evidence of painful motion with functional loss to support a 10% ratings for either knee (based on §§4.59, 4.40 and 4.45). There was no limitation of flexion or extension (5260 or 5261), no meniscal surgery (5259), no evidence of dislocated meniscus or loss body causing frequent locking with recurrent effusions (5258), or fracture, nonunion or malunion of the femur or tibia causing a knee impairment (5255, 5262) to  support

a rating for either knee under those codes. There was no additional functional limitation evidenced by the examinations. Only the right knee showed objective degenerative changes, and therefore the 10% rating analogous to code 5003 for “X-ray evidence of involvement of two or more major joints or two or more minor joint groups” was not applicable. 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.

AR20190008478, 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.