RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE: PD-2018-00430 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20090317

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

CI CONTENTION: “I was discharged from the Army with a disability status and I am wondering if it should have been a disability retirement status.” 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 - 20081220	VARD - 20100125	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Knee Pain	5099-5003	10 + 10 = 20%	Right Knee Patellofemoral Syndrome	5299-5260	10%	20090930	
			Left Knee Patellofemoral Syndrome	5299-5260	10%		
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 30%	

ANALYSIS SUMMARY:

Bilateral Knee Pain. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s bilateral knee condition began during Basic Combat Training. Her medical treatment included a temporary profile, arch supports, non-steroidal anti-inflammatories and a home exercise program. Her care continued while deployed. Upon re-deployment, an MRI of both knees revealed joint effusions as well as bilateral "discrete subluxation of the patella.” In March 2008 orthopedics diagnosed her condition as "bilateral patellofemoral syndrome.”

At the 12 November 2008 NARSUM examination, 4 months prior to separation, the CI reported constant bilateral knee pain “right above the knee cap” slightly worse on the right, that "goes all around" the knee. Her symptoms were aggravated by maneuvering stairs and sitting. The physical examination (PE) revealed painful and limited motion of both knees. Right knee flexion measured to 135 degrees (normal 140) and extension to -5 degrees (normal 0). Left knee flexion was to 133 degrees and extension to -4 degrees. There was tenderness present below both kneecaps.  There was no joint line tenderness or evidence of joint instability to either knee.

At the 30 September 2009 VA Compensation and Pension (C&P) examination, 6 months after separation, the CI reported bilateral knee pain. Her PE of both knees revealed tenderness, but there were no signs of edema, instability, abnormal movement, effusion, weakness, redness, heat, deformity, guarding of movement, malalignment, drainage, or subluxation to either knee. ROM was within normal limits, bilaterally.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the bilateral knee condition at 10% each knee, analogously coded 5099-5003 (degenerative arthritis), citing painful motion of two major joints. The VA also rated the right and left knee condition 10% each, analogously coded 5299-5260 (leg, limitation of flexion), based on the C&P examination, citing painful motion. There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261). However, there was evidence of painful motion with functional loss supporting a 10% rating (based on
§§4.59, 4.40 and 4.45). There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to support a rating under that code. 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). There was therefore no VASRD §4.71a rating higher than the combined 20% adjudicated by the PEB under any applicable code. 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 §4.59, 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.

2	PD-2018-00430
AR20190008490, 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.