RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2018-00183
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051114

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, M1 Armor Crewman, medically separated for “bilateral knee pain” with a disability rating of 10%.  

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 - 20050908	VARD - 20060316	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Knee Pain	5099-5003	10%	Anterior Cruciate Ligament (ACL) Tear, Right Knee	5257	10%	20051115	
			Degenerative Joint Disease, Left Knee	5010-5257	10%	20051115	
COMBINED RATING:  10%	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 underwent bilateral ACL surgeries in May 2005, but experienced post-surgical painful motion in both knees that limited duty performance.  During the 26 May 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported left knee arthritis and a torn right knee ACL.  Physical examination showed healing scars, and “decreased” left knee range of motion (ROM) was recorded.  The 1 August 2005 MEB NARSUM examination, 3 months before separation, noted complaints of bilateral knee pain and stiffness.  Right knee ROM was from 0-130 degrees (normal 0-140), and left knee ROM was from 0-135 degrees, with painful motion bilaterally.  Instability testing was negative for both knees.

At the 15 November 2005 VA Compensation and Pension (C&P) examination, 1 day after separation, the CI reported bilateral knee pain.  Physical examination showed a normal gait.  Bilaterally knee flexion was to 140 degrees and extension to 0 degrees, with painful motion; instability was not addressed.
The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral knee condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing the US Army Physical Disability Agency pain policy.  The VA rated the right knee condition 10%, coded 5257 (knee, other impairment), and the left knee condition dual coded 5010-5257 (arthritis, due to trauma-knee, other impairment), based on the C&P examination, citing painful motion.  Panel members first considered whether each knee condition remained separately unfitting, having been decoupled from the bundled knee PEB adjudication.  Each knee condition was profiled, implicated by the commander’s performance statement, and failed retention standards.  There was not a preponderance of evidence to show that either knee condition was not reasonably justified as separately unfit.  Accordingly, the panel recommends a separate service rating for each knee condition, and agreed there was no compensable limitation of flexion or extension (5260 or 5261) for either; however, there was sufficient evidence of painful motion and functional loss to support a 10% rating for each knee IAW §4.59 and §4.40, as reported on the MEB NARSUM and VA examinations.  Knee instability testing performed during the MEB NARSUM examination was negative, which did not lend support for a rating under code 5257.  The panel considered other VASRD knee and analogous codes, but all were less applicable and/or not advantageous for rating.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right knee condition, and 10% for the left knee condition, coded 5299-5260.

BOARD FINDINGS:  In the matter of the bilateral knee condition, the panel recommends unfitting right and left knee conditions, each rated 10%, and both coded 5299-5260 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Right Knee Pain	5299-5260	10%	
Left Knee Pain	5299-5260	10%	
COMBINED	20%	

The following documentary evidence was considered:

AR20200004702

Dear XXXXXXXXXXXXXXXXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.