RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2018-00300
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070425

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

CI CONTENTION:  Review requested of the leg and gastroesophageal reflux conditions, as well as additional conditions not identified by the MEB and/or Physical Evaluation Board (PEB).    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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20070306	VARD - 20080422	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral 
Knee Pain	5099-5003	0%	Bilateral Meniscus Tear	5257	0%	20071213	
			Patellar Tendonitis, Right	5024	0%	20071213	
			Residuals, Stress Fracture, Left Femur	5255	0%	20071213	
Gastroesophageal Reflux	Not Unfitting	GERD	7203-7346	0%	20071213	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Bilateral Knee Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s knee pain began in 2003 during basic training but without specific trauma or injury.  Bilateral knee MRIs from October 2006 showed changes within each medial meniscus, noted to likely be degenerative.  At an orthopedic examination on 30 November 2006, 5 months prior to separation, physical examination showed tenderness of the patellofemoral joint and patellar ligament bilaterally.  There was crepitus, greater on the right, but no swelling, and both knees were stable with no locking.  Measured range of motion (ROM) was full with complaint of pain at 90 degrees of flexion.  The diagnosis was bilateral patellar chondromalacia, right greater than left, and surgery was not indicated.  

At the 15 January 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months before separation, the examiner noted a tender patella but “otherwise normal exam.”  The 22 February 2007 MEB NARSUM examination recorded complaints of dull aching pain of both knees that was sharp at times.  Physical findings showed stable knees with soft tissue swelling at the inferior aspects and positive meniscal signs bilaterally.  Measured ROM revealed flexion to 90 degrees (normal 140) and extension to 0 degrees (normal).  

At the 13 December 2007 VA Compensation and Pension (C&P) examination, 8 months after separation, the CI reported pain when navigating stairs and running.  Physical examination of both knees revealed medial and lateral joint line tenderness, without effusion or instability, but with positive McMurray’s tests for meniscal pathology.  Right knee flexion was to 135 degrees and extension of 0 degrees, whereas the examiner noted the left knee had “full” ROM, with no painful motion noted for either knee.  Bilateral ROM was not additionally limited due to pain, weakness, fatigability, or lack of endurance after repetitive use or flare-ups.  Bilateral knee X-rays were negative.  

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 degenerative joint disease with no mechanical loss of motion.  The VA also rated the bilateral knee condition 0%, but coded 5257 (other knee injury), based on the C&P examination, citing no recurrent subluxation or lateral instability of the knee.  The panel first considered whether each of the knee conditions, having been de-coupled from the combined PEB adjudication, remained separately unfitting.  In this case, both knees were profiled, implicated by the NARSUM and 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, and thus panel members agreed that each knee was reasonably justified as separately unfitting and eligible for disability rating.  While there was no compensable limitation of flexion or extension (5260 or 5261) of either knee, there was evidence of painful motion with functional loss to support a 10% rating for each knee (based on §4.59, §4.40 and §4.45) based on examinations proximate to separation.  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 disability ratings of 10% each for the unfitting right and left knee conditions, both coded 5099-5003.  

Contended PEB Condition:  Gastroesophageal Reflux.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement, and did not fail retention standards.  There was no performance-based evidence from the record that the condition 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 the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the bilateral knee condition, the panel recommends unfitting right and left knee conditions, rated 10% each, and both coded 5099-5003 IAW VASRD §4.71a.  In the matter of the contended gastroesophageal reflux condition, the panel recommends no change from the PEB determination as not unfitting.  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	
Chronic Right Knee Pain	5099-5003	10%	
Chronic Left Knee Pain	5099-5003	10%	
COMBINED	20%	

The following documentary evidence was considered:

AR20200009858 

Dear XXXXXXXXXXXXXXXXXXX:

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.