RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX   	CASE:  PD-2020-00040
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040916

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

CI CONTENTION:  Review requested of additional conditions not identified by the Medical Evaluation Board (MEB) and 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 - 20040525	VARD - 20060118	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Knee Pain	5099-5003	0%	Degenerative Joint Disease, Left Knee	5010	10%	20051025	
			Degenerative Joint Disease, Right Knee	5010	10%	20051025	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  100% 	

ANALYSIS SUMMARY:  

Bilateral Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI began having right knee pain in April 2002 and left knee pain in January 2004.  He had traumatic events that precipitated the pain in both knees.  X-rays at the time showed no fractures.  Later X-rays revealed mild compartmental degenerative arthritic changes, most specifically on the medial joint line on the right knee and the patellofemoral joint.   

The 1 April 2004 MEB NARSUM examination, 5 months prior to separation, noted complaints of continued pain in both knees with any type of physical activity to include bending, kneeling, squatting or prolonged standing.  Physical examination of the right knee showed range of motion (ROM) was from 0 to 120 degrees (normal 0-140) with pain at extreme ranges of motion.  He had a positive patellofemoral grind and pain with palpation over his patella.  Tests of knee instability were negative for both knees.  Examination of the left knee showed tenderness and a positive patellofemoral grind.  There was joint line tenderness, both anteriorly, medially, and laterally.  Left knee ROM was not provided.  At the MEB addendum examination on 30 April 2004, the right and left knee ROMs following repetitive movement were flexion of 80/75 degrees (normal 140) and extension of 0/0 degrees (normal).  There was severe pain on flexion motion beyond the 75-degree mark in both knees.  

At the 25 October 2005 VA Compensation and Pension (C&P) examination, 13 months after separation, the CI complained of constant lower extremity pain, not localized to the knees, and radiating "up to the stomach and down to the feet," graded 10/10.  Directed active ROM, right/left, was extension 0/0, flexion 34/40, with seated flexion to 90 degrees bilaterally, limited further volitionally, and with complaint of pain throughout ROM testing and with repetition.  Flexion over pressure maneuver, drawer, patellofemoral, and McMurray's tests were all unobtainable due to volitional guarding.  Lachman's test demonstrated a slight and symmetrical medial collateral ligament laxity, but with firm endpoint.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB bundled and rated the left and right knee conditions 0%, analogously coded 5099-5003 (degenerative arthritis), citing painful full ROM.  There was no evidence of ligamentous laxity and radiographs noted degenerative arthritis.  The VA rated the each knee condition 10%, coded 5010 (traumatic arthritis), based on the C&P examination.  

Panel members first considered whether the left and right knee conditions, having been de-coupled from the combined PEB adjudication, remained separately unfitting.  The panel noted that the objective findings and associated disability for each knee were similar, thus, the panel members agreed that the evidence reasonably justified that each was reasonably unfitting, and accordingly a separate disability rating is supported.  The panel next agreed that there was sufficient evidence of painful motion and functional loss to support a 10% rating for each knee IAW §4.59 and §4.40.  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 left knee, and 10% for the right knee, each coded 5010.  

BOARD FINDINGS:  In the matter of the bilateral knee condition, the panel recommends a disability rating of 10% for the left knee and 10% for the right knee, each coded 5010 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	
Degenerative Joint Disease, Left Knee	5010	10%	
Degenerative Joint Disease, Right Knee	5010	10%	
COMBINED	20%	

Dear XXXXXXXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified to 20% 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 and to the counsel you listed on your application; XXXXXXXXXXXXXXXXX

Sincerely,