RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-01291
BRANCH OF SERVICE:  Army	BOARD DATE: 20150122
SEPARATION DATE:  20041211

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E-2 (Basic Trainee) medically separated for chronic bilateral knee pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty but he could complete an alternate physical fitness test.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The bilateral knee condition, characterized as “bilateral knee pain,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “chronic bilateral knee pain” as unfitting, rated 0% citing criteria of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.

CI CONTENTION:  “I was found undeployable, couldn’t stand for long periods of time, march or run.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited 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 PEB, but determined to be not unfitting.  Any conditions outside the Board’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/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation. 

RATING COMPARISON:

Service IPEB – Dated 20041007 | VA - 9 years post separation
Condition | Code | Rating | Condition | Code | Rating | Exam
Chronic Bilateral Knee Pain | 5099-5003 | 0% | Left Knee Strain | 5257 | NSC | 20130701
Other x 0  (Not in Scope) | Other x 1
Combined:  0% | Combined:  0%
Derived from VA Rating Decision (VARD) dated 20130729 (most proximate to date of separation [DOS]).   CI “no showed” for radiology portion of the C&P exam.

ANALYSIS SUMMARY:

Chronic Bilateral Knee Pain:  The CI reported onset of bilateral anterior knee pain during basic training.  X-rays of both knees were normal.  Evaluation in the clinic concluded with diagnosis of patellofemoral pain syndrome.  The CI reported persistent pain despite treatment that prevented passing the 2 mile run on the physical fitness test.  Although he was medically cleared to perform the alternate physical fitness walk test, this option was rejected by his unit and he was referred for MEB.  The physical therapy range-of-motion examination performed on 4 August 2004, recorded flexion to 128 degrees (normal 140) and extension of 0 degrees (normal 0) for both knees.  There was pain at the extreme of flexion in the left knee.  At the time of the MEB narrative summary (NARSUM) examination on 30 August 2004, the CI reported knee pain preventing running.  On examination, the gait was normal.  Both knees flexed to 135 degrees and extended to 0 degrees.  There was no muscle atrophy, tenderness, swelling, or instability.  The examiner commented that there were no objective findings on the physical examination.  There was no VA examination proximate to separation from service.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB combined the right and left knee conditions as a single unfitting condition coded analogously to 5003 and rated at 0%.  The 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 or implied adjudication that each condition was separately unfitting.  The Board also noted that “bundling,” the combining of two or more major joints is permissible under the VASRD code 5003 rating requirements, and that this approach did not compromise the VASRD §4.7 directive to choose the higher of two valid ratings.  The Board’s initial charge in this case was therefore directed at determining if the PEB’s approach of combining the two conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the Board considered 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 Disability Evaluation System or be found unfit because of physical disability.  When the Board recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  In this case both knees were reported as preventing performance of duties without differentiation between individual knees.  Therefore, the Board did not find evidence that indicated one or both knees when considered alone was not unfitting for military service.  There was no limitation of motion of either knee that supported a minimum rating for limitation of flexion (code 5260) or extension (code 5261), and there was no instability or meniscus problem to support minimum ratings under relevant codes (5257, 5258, or 5259).  There was no painful motion reported at the time of the MEB NARSUM examination to support a minimum rating based on §4.59.  The Board noted the limitation on running but the examination recorded a normal gait.  The Board concluded there was not sufficient evidence to support a minimum 10% rating for functional loss (§4.40) in the average civil occupation (§4.1).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the bilateral knee pain condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  As discussed above, PEB reliance on the USAPDA pain policy for rating the bilateral knee pain was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the bilateral knee pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.
RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130112, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

		
XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXX, AR20150009874 (PD201301291)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation and hereby deny the individual’s application.  This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl			     XXXXXXXXXXXXXXX
			     Deputy Assistant Secretary of the Army
			         (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA

PD-2013-01291