RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY
CASE NUMBER: PD1100723 SEPARATION DATE: 20060620
BOARD DATE: 20121101
SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this
covered individual (CI) was an active duty SPC/E-4 (11B/Infantry Rifleman), medically separated
for a bilateral knee condition. He did not respond adequately to conservative treatment and
was unable to perform within his Military Occupational Specialty (MOS), meet worldwide
deployment standards or meet physical fitness standards. He was issued a permanent L3
profile and underwent a Medical Evaluation Board (MEB). Plica syndrome was forwarded to
the Physical Evaluation Board (PEB) as medically unacceptable IAW AR 40-501. No other
conditions appeared on the MEBs submission. The PEB adjudicated the bilateral knee
condition as a single unfitting condition, rated 10%, with application of the US Army Physical
Disability Agency (USAPDA) pain policy. The CI made no appeals, and was medically separated
with a 10% disability rating.
CI CONTENTION: As the rating from the VA (40%) substantially differs from the PEB rating
(10%), this difference should be addressed and uniformed if at all possible.
SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI
6040.44, Enclosure 3, paragraph 5.e. (2) is limited to those conditions which were determined
by the PEB to be specifically unfitting for continued military service; or, when requested by the
CI, those condition(s) identified but not determined to be unfitting by the PEB. The ratings
for unfitting conditions will be reviewed in all cases. The bilateral knee condition, as requested
for consideration meet the criteria prescribed in DoDI 6040.44 for Board purview; and, are
addressed below. The other requested conditions, although not specifically stated, bilateral
carpal tunnel syndrome and right ear hearing loss (which was part of the 40% rating from the
VA) are not within the Boards purview. Any conditions or contention not requested in this
application, or otherwise outside the Boards defined scope of review, remain eligible for future
consideration by the Army Board for Correction of Military Records.
RATING COMPARISON:
Service IPEB Dated 20060508
VA (10 Mos. Post-Separation) All Effective Date 20060621
Condition
Code
Rating
Condition
Code
Rating
Exam
Chronic pain both knees
secondary to Plica
syndrome
5099-5003
10%
R knee Patellar Tendonitis
5024
10%
20070424
L knee Patellar Tendonitis
5024
10%
20070424
.No Additional MEB/PEB Entries.
L Carpal Tunnel Syndrome
8515
10%
20070424
R Carpal Tunnel Syndrome
8515
10%
20070424
0% X 1 / Not Service-Connected x 3
20070424
Combined: 10%
Combined: 40%
ANALYSIS SUMMARY: The Board acknowledges the CIs contention that suggests ratings should
have been conferred for other conditions documented at the time of separation. The Board
wishes to clarify that it is subject to the same laws for disability entitlements as those under
which the Disability Evaluation System (DES) operates. While the DES considers all of the
member's medical conditions, compensation can only be offered for those medical conditions
that cut short a members career, and then only to the degree of severity present at the time of
final disposition. However the Department of Veterans Affairs (DVA), operating under a
different set of laws (Title 38, United States Code), is empowered to compensate all service-
connected conditions and to periodically reevaluate said conditions for the purpose of adjusting
the Veterans disability rating should the degree of impairment vary over time.
Bilateral Knee Condition (Plica Syndrome). The CIs bilateral knee pain began gradually without
trauma and did not improve adequately with treatment which included non-steroidal
medication, physical therapy, ultrasound treatments, a cortisone injection and limited duty. X-
rays and bone scan were normal and he was referred to orthopedics. After an exam and a
review of the magnetic resonance imaging (MRI) results, the examiner diagnosed Plica
syndrome and patellar tendonitis and offered surgery. Due to a low percentage rate of success
with surgery, the CI declined. There were two goniometric range-of-motion (ROM) evaluations
in evidence, with documentation of additional ratable criteria, which the Board weighed in
arriving at its rating recommendation; as summarized in the chart below.
DOS 20060620
Knee ROM
P.T. exam for MEB ~5 Mo. Pre-Sep
VA C&P ~4 Mo. Post-Sep
Left
Right
Left
Right
Flexion (140° Normal)
125°
120°
110°
120°
Extension (0° Normal)
5°
0°
0°
0°
Comment
Gait limping,
painful
motion
Gait limping,
painful motion
Normal gait;
additional LOM
with repetitive
use at 90°
Normal gait; NO
additional LOM
with repetitive
use
§4.71a Rating
10%
10%
10%
10%
At the MEB exam, the CI reported bilateral knee pain, worse with running with an intensity of 3-
4 of 10 on a pain scale. The MEB physical exam documented a limping gait and normal
neurologic findings. The MRI performed in October 2005 revealed possible bone bruise on the
medial femoral condyle, small joint effusion and on the left a suggestion of a partial anterior
cruciate ligament (ACL) tear and a joint effusion. The examiner diagnosed Plica syndrome and
documented the CI was not working in his MOS, could not run or rucksack and could not
perform his duties as an infantryman. At the VA Compensation and Pension (C&P) exam the CI
reported progressively worsened knee pain with activity and that he took Aleve 3-4 times per
day for relief. The C&P exam demonstrated painful motion, crepitation and grinding, no
instability or giving way, normal gait, able to stand for an hour, able to walk ¼ of a mile, no
Deluca observations on the right but noted on the left with further limitation motion to 90
degrees due to pain. X-rays were negative.
The Board directs attention to its rating recommendation based on the above evidence. The
PEB combined the separate knee conditions under a single rating, coded analogously to 5003.
This coding approach is countenanced by AR 635-40; but, IAW DoDI 6040.44, the Board must
apply separate codes and ratings in its recommendations if compensable ratings for each joint
are achieved IAW VASRD §4.71a. When the Board judges that two or more separate ratings are
warranted in such cases, however, it must satisfy the requirement that each unbundled
condition was unfitting in and of itself. All members agreed that no distinctions between the
two joints could be made regarding functional limitations, and that it was reasonable to
concede that either knee alone would have resulted in the same fitness consequences. The
PEBs analogous rating to 5003 (degenerative arthritis) for chronic pain both knees secondary
to Plica syndrome, could justify a single rating for both joints absent painful motion. The VA
achieved separate 10% ratings with application of VASRD §4.59 (painful motion). The MEB
examiner did document painful motion; and, therefore agreed it could not consider the 5003
code at 10% as a single rating. The Board concedes §4.59 to achieve the minimal compensable
rating (10%) for each joint. After due deliberation and mindful of VASRD §4.3 (reasonable
doubt), the Board consensus was that separate ratings were supported; and, the Board
recommends a disability rating of 10% each for the left and right knees. The action officer
recommended, and the Board concurred with, the code 5099-5024 (Tenosynovitis) for its
clinical compatibility with patellofemoral syndrome (PFS).
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. The Board did not
surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD
were exercised. As discussed above, PEB reliance on the USAPDA pain policy for rating bilateral
knee condition was operant in this case and the condition was adjudicated independently of
that policy by the Board. In the matter of the bilateral knee condition, the Board unanimously
recommends that each joint be separately adjudicated as follows: an unfitting left knee
condition coded 5099-5024 and rated 10%, and an unfitting right knee condition coded 5099-
5024 and rated 10%; both IAW VASRD §4.71a. There were no other conditions within the
Boards scope of review for consideration.
RECOMMENDATION: The Board recommends that the CIs prior determination be modified as
follows, effective as of the date of his prior medical separation:
UNFITTING CONDITION
VASRD CODE
RATING
Right knee pain secondary to Plica syndrome/tendonitis
5099-5024
10%
Left knee pain secondary to Plica syndrome/tendonitis
5099-5024
10%
COMBINED (w/ BLF)
20%
The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20110830, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record
xxxxxxxxxxxxxxxxxxxxxx, DAF
President
Physical Disability Board of Review
SFMR-RB
MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD-ZB / xxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557
SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for xxxxxxxxxxxxxxxxxxxxx, AR20130004947 (PD201100723)
1. 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 Boards recommendation to modify the individuals disability rating to 20%
without recharacterization of the individuals separation. This decision is final.
2. I direct that all the Department of the Army records of the individual concerned be
corrected accordingly no later than 120 days from the date of this memorandum.
3. I request that a copy of the corrections and any related correspondence be provided
to the individual concerned, counsel (if any), any Members of Congress who have
shown interest, and to the Army Review Boards Agency with a copy of this
memorandum without enclosures.
BY ORDER OF THE SECRETARY OF THE ARMY:
Encl xxxxxxxxxxxxxxxxxxxxxxx
Deputy Assistant Secretary
(Army Review Boards)
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