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AF | PDBR | CY2011 | PD2011 00949
Original file (PD2011 00949.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX         CASE: PD1100949
BRANCH OF SERVICE: Army  BOARD DATE: 20130905
SEPARATION DATE: 20030418


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (71L/Administrative Specialist) medically separated for a bilateral knee condition. He developed an atraumatic onset of bilateral knee pain in basic training which persisted, was not associated with surgical pathology, and did not respond adequately to conservative treatment to meet the physical requirements of his Military Occupational Specialty. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The condition, characterized as “bilateral knee pain, left knee medial condyle chondromalacia,” was forwarded as the sole condition to the Physical Evaluation Board (PEB), judged to fail retention standards IAW AR 40-501. The PEB adjudicated “chronic bilateral knee pain secondary to chondromalacia” as a single unfitting condition, rated 0%, citing Veterans Affairs Schedule for Rating Disabilities (VASRD) criteria for code 5003 (degenerative arthritis). The CI made no appeals and was medically separated.


CI CONTENTION: The CI elaborated no specific contention in his application.


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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI. The rating for the unfitting knee condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board. Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.


RATING COMPARISON:

Service IPEB – Dated 20030320
 VA - Based on Service Treatment Records (STR)*
Condition
 Code Rating Condition Code Rating Exam
Chronic Bilateral Knee Pain 2⁰ to Chondromalacia
 5099-5003 0% Chondromalacia, Left Knee 5299-5260 10% STR
Chondromalacia, Right Knee 5299-5260 10% STR
Combined: 0%
 Combined: 20%
Derived from VA Rating Decision (VA RD ) dated 200 30421 ( most proximate to date of separation [ DOS ] ).
* VA rating evaluation was performed 20031128 (7 months post-separation), with no rating change in subsequent VARD.


ANALYSIS SUMMARY:

Bilateral Knee Condition. The CI reported an onset of bilateral knee pain and swelling with running during basic training, which was diagnosed and treated as a strain. The symptoms persisted and were more acute on the left. He was first profiled (L2) for his left knee in June 2002, and his final permanent L3 profile was also only for the left knee; but, various STR entries confirm the presence of bilateral symptoms. Magnetic resonance imaging (left knee only) revealed some moderate chondromalacia. No STR entries document gait disturbance, painful motion, effusion, instability or gross range-of-motion (ROM) limitations of either knee. The commander’s statement noted the CI’s limitations, but referred only to his “medical condition” as the cause. The narrative summary (NARSUM) documented a chief complaint of “bilateral knee pain, left greater than right.” Limitations were cited as an inability to run, ability to walk a mile (followed by pain and swelling left greater than the right), and inability to ruck march. The NARSUM physical exam noted mild medial tenderness bilaterally, no effusion, and no instability to stress testing in all planes. The documented ROM was flexion to 125 degrees (normal 140 degrees; minimal compensable 45 degrees) bilaterally, which the examiner judged to be normal given the well-developed musculature. Painful motion was not described. At the VA Compensation and Pension (C&P) evaluation (7 months post-separation, see footnote to rating comparison chart) the examiner noted bilateral pain (specifying that neither was worse) rated 2/10, with flares to 7/10 provoked by “prolonged standing and walking of greater than 1 ½ hours or kneeling for greater than 10 minutes.” The VA physical exam noted the absence of tenderness, effusion, or instability. The ROM measurements were 0 degrees extension (normal) and 140 degrees flexion bilaterally. The examiner documented “bilateral crepitance with range of motion,” but did not specify painful motion; including with repetitive use.

The Board directs attention to its rating recommendation based on the above evidence. The PEB’s bilateral rating of 0% analogously to 5003 (degenerative arthritis) does not comport with the VASRD §4.71a 10% rating under 5003 for two or more major joints, the latter without regard to ROM limitation or other factors. Although §4.71a permits combined ratings of two or more joints under 5003, it allows separate ratings for separately compensable joints. The VARD cited painful motion as its rationale for separate ratings; but, as noted above, that conclusion cannot be supported by the C&P evidence. If the Board judges that separate codes and ratings are supported under §4.71a, moreover, members must further agree that each joint is reasonably justified as separately unfitting in order to be eligible for service rating. The evidence is clear that the left knee dominated the disability in this case, and it was the only one profiled. Although the commander’s statement provides no clarification, it remains that the bilateral condition was judged to fail retention standards; and, the STR, NARSUM, and C&P evaluation provide ample evidence that the right knee made a relevant contribution to the disability. Members agreed, therefore, that each knee should be conceded as separately unfitting; although, there was unanimous reservation as to whether separate ratings could be justified under §4.71a. There is no evidence for ROM impairment, ligamentous laxity, frequent effusions, or locking which would support a rating higher than 10% under any applicable code; or grounds for additional rating of instability. A minimum 10% rating under any unilateral code would require satisfactory evidence of painful motion (VASRD §4.59) or meet criteria of VASRD §4.40 (functional loss). Upon deliberation, members agreed that there was insufficient evidence to support the application of either §4.59 or §4.40; and, it was thus concluded that separate ratings could not be justified by §4.71a criteria. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the bilateral knee condition. The action officer recommended, and members concurred with, the code 5014 (chondromalacia analogous to osteomalacia) which defaults to 5003 criteria.


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. In the matter of the bilateral knee condition, the Board unanimously recommends a disability rating of 10%, coded 5014-5003 IAW VASRD §4.71a.

RECOMMENDATION: The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

UNFITTING CONDITION VASRD CODE RATING
Chronic Bilateral Knee Pain Associated with Chondromalacia 5014-5003 10%
COMBINED 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20111019, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record





XXXXXXXXXXXXXXXXXX, DAF
President
Physical Disability Board of Review






 SFMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD-ZB / XXXXXX ), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557


 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXX , AR20130021924 (PD201100949)
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 Board’s recommendation to modify the individual’s disability rating to 10% without recharacterization of the individual’s 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                                                  XXXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary
                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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