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AF | PDBR | CY2012 | PD2012 01531
Original file (PD2012 01531.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW


NAME:    CASE: PD1201531
BRANCH OF SERVICE: Army  BOARD DATE: 20130425
SEPARATION DATE: 20051128


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (42A20/Human Resources) medically separated for bilateral knee pain. She had onset of knee pain in 2004 while deployed to Iraq. Despite conservative treatment, the CI’s condition did not improve adequately to fully perform her military duties or meet physical fitness standards. She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The bilateral knee condition, characterized as “ patello femoral syndrome , ” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501 . The MEB also listed “ old disruption of anterior cruciate ligament” and “myalgia and myositis” on the DA Form 3947. The PEB found the chronic bilateral knee pain unfitting and rated it 0% IAW the US Army Physical Disability Agency (USAPDA) pain policy. The other conditions were determined to be not unfitting . The CI made no appeals and was medically separated with 0% disability.


CI CONTENTION: “In 2005, I was board for Chronic bilateral knee pain due to patellofemoral syndrome, old disruption of anterior cruciate ligament, myalgia and myositis I believe that my rating is inaccurate due to the fact that upon discharge from the military I was awarded compensation from the Department of Veterans Affairs for these disabilities, and secondly I have served the US Army with commitment, dedication and selfless service. Because of the injuries or conditions l have endured, it has caused me not to have the same commitment to the family I serve every day. Since my service in the military now and forever I have to choose carefully what I do career wise, and physically in order to elongate the longevity of my health to be able to service my family. I respectfully ask that you please reconsider and review my rating for fairness and accuracy. Thank you.”


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 bilateral knee condition is addressed below. The requested anterior cruciate ligament (ACL), and myalgia and myositis conditions, which were determined to be not unfitting by the PEB, are likewise addressed below. Any conditions or contention not requested in her application, or otherwise outside the Board’s defined scope of review, may be eligible for future consideration by the respective Service Board for Correction of Military Records.






RATING COMPARISON :

Army PEB – dated 20051018
VA - (1 mo. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Bilateral Knee Pain 5099-5003 0% Left Knee Pain 5260 10% 20051030
R ight Knee Pain , Status Post
A CL Repair 		5010-5260 10% 20051030
Old Disruption o f A CL Not Unfitting
Myalgia a nd Myositis. Not Unfitting Myositis with Myalgia 5021 0% 20051030
No Additional MEB/PEB Entries
 Other x 9 20051030
Combined: 0%
 Combined: 70%
Derived from VA Rating Decision (VA RD ) dated 200 60502 ( most proximate to date of separation )


ANALYSIS SUMMARY:

Bilateral Knee Pain. While deployed to Iraq in 2004, the CI developed pain in both knees. She was medically evacuated from theater and later evaluated by Orthopedics, and was diagnosed with right knee degenerative joint disease (DJD). She was treated, but continued to have persistent problems with knee pain, so a MEB was initiated. The MEB physical examination (PE) was done in August 2005. The CI had no pain at the time of that exam. There was no effusion, no swelling, no erythema (redness), no warmth, no crepitus, no patellar grind, and no lateral patellar tracking. Both knees had full range-of-motion (ROM). Lachman’s test, varus/valgus stress testing, and McMurray’s test were all negative. The examiner decided to refer the CI for psychiatry or psychology consultation, but the CI refused.

On 31 October 2005, the CI had a VA Compensation and Pension (C&P) exam, a month prior to separation from service. PE of the knees revealed no swelling, effusion, or wasting of the quadriceps. There was pain and crepitation on pressure over the patella. Flexion was 130 degrees in both knees, with no pain on motion. Repeated and resisted motion caused a 20 degree reduction in the ROM of the knees.
The Board carefully reviewed all available evidence. The Army PEB combined the two knee problems into a single unfitting condition, characterized as “chronic bilateral knee pain due to patellofemoral syndrome.” The condition was coded 5099-5003 and rated at 0%. The April 2004 VA Rating Decision unbundled the two knee conditions, and assigned a rating of 10% to each joint. The Board considered whether or not it was appropriate for the two knee problems to be “bundled” together. The Board must determine if the PEB’s approach of combining the conditions under a single rating was justified in lieu of separate ratings. The Board must apply separate codes and ratings in its recommendations if compensable ratings for each condition are achieved IAW the Veterans Affairs Schedule for Rating Disabilities (VASRD). If the Board judges that two or more separate ratings are warranted, however, it must satisfy the requirement that each “unbundled” condition was separately unfitting. After due deliberation, the Board agreed that the evidence did not support a conclusion that each of the knee pain conditions separately would have rendered the CI unable to perform her required military duties. Therefore, the Board does not recommend a separate Service disability rating for each knee. It is appropriate for the two knees to be “bundled” together and treated as a single unfitting condition.

After consideration of the knee examinations noted above, the Board determined that the October 2005 C&P exam had greater probative value since it was conducted just a month prior to the date of separation. Using data from the October 2005 C&P exam, the bilateral knee condition is essentially non-compensable based solely on the VASRD §4.71a codes for loss of knee motion (5260 & 5261). However, based on the legal ruling from DeLuca v. Brown (1995), the Board must consider any additional functional loss due to pain, flare-ups, deformity, tenderness, arthritis, loss of motion on repetitive use, weakened movement, excess fatigability or incoordination. During that October 2005 C&P exam, the examiner documented loss of motion with repetitive movement. Also, IAW VASRD §4.40 (Functional loss), a part of the musculoskeletal system which becomes painful on use must be regarded as seriously disabled. After due deliberation, the Board determined that a rating of 10% was warranted, due to loss of motion with repetitive movement, and pain which occurs with use of the knees. The Board tried to find a path to a rating higher than 10%, using other codes which could be applied to the knee condition. The other VASRD codes that were considered did not result in a higher rating, since the record did not show evidence of a significantly disabling knee abnormality which would justify a rating higher than 10%. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board unanimously recommends a disability rating of 10% for the chronic bilateral knee pain, due to patellofemoral syndrome.

Other PEB Conditions. Disruption of ACL, and myalgia/myositis were adjudicated by the PEB as not unfitting. The Board’s main charge with regard to these conditions is to assess the fairness of the PEB’s fitness determination. The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard. These conditions were not specifically implicated in the commander’s statement, or judged to fail retention standards. They were reviewed by the action officer and considered by the Board. There was not sufficient evidence in the record that either of these conditions significantly interfered with satisfactory duty performance. After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for these other PEB conditions. Therefore, no additional disability ratings are recommended.


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 noted above, PEB reliance on the USAPDA pain policy was operant in this case and the bilateral knee condition was adjudicated independently of that policy by the Board. In the matter of the bilateral knee pain due to patellofemoral syndrome, the Board unanimously recommends a disability rating of 10%, coded 5099-5003, IAW VASRD §4.40 and §4.71a. In the matter of the old disruption of ACL and the myalgia/myositis, the Board unanimously recommends no change in the PEB adjudication as “not unfitting, not rated.” There were no other conditions within the Board’s scope of review for consideration.


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

UNFITTING CONDITION
 VASRD CODE RATING
Chronic, Bilateral Knee Pain 5099- 5003 1 0%
COMBINED
 10%



The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120828, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




         Physical Disability Board of Review


 SFMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD-ZB),


 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for AR20130011068 (PD201201531)
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                                                 
                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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