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AF | PDBR | CY2013 | PD-2013-02595
Original file (PD-2013-02595.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2013-02595
BRANCH OF SERVICE: Army  BOARD DATE: 20150409
SEPARATION DATE: 20030604


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6 (CID Special Agent) medically separated for a chronic bilateral knee condition. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The bilateral knee condition, characterized as “patellofemoral pain syndrome” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded one other condition (hypertension) as medically acceptable. The Informal PEB adjudicated “chronic bilateral knee pain due to patellofemoral syndrome” as unfitting, rated 10%, with application of the US Army Physical Disability Agency (USAPDA) pain policy. The CI made no appeals and was medically separated.


CI CONTENTION : “ My comma n der submitted a le t ter to the review board stating that I not be s ep arated throug h the US Army Disability System. Military rating was low with o nly one medical issue awarded. Also after a combined U.S. Air Force and U.S. Army commitment of 15 years 9 months I was not offered the option of retirement. I was medically di scharged with a rating of 10%. ”


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 20030205
 VA* - (6 Mos. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Bilateral Knee Pain Due to PFS 5099-5003 10% RPPS, Left Knee 5299-5260 0% 20021126
RPPS, Right Knee 5299-5260 0% 20021126
Hypertension Medically Acceptable Hypertension 7101 0% 20030818
Other x 1 (Not in Scope)
 Other x 3
Combined: 10%
 Combined: 10%
* Derived from VA Rating Decision s (VA RD s ) dated 200 30616 and 20040210 ( most proximate to date of separation [ DOS ] ) .


ANALYSIS SUMMARY:

Bilateral Knee Condition. The CI had a history of bilateral, atraumatic knee pain dating back to the early 90’s. He was issued a permanent P2 profile and treated with physical therapy and medications and was able to continue his duty requirements, but his pain progressed to the point that he could no longer walk over two miles. On examination, he was noted to have a stable knee, but signs of patellar irritation. He was issued an L3 profile and referred to an MEB.

The narrative summary and MEB examination were dated 26 November 2002. The CI reported pain with standing over 20 minutes and walking was limited to less than two miles. He occasionally used a back brace. He also reported back and bilateral hip pain which he attributed to the knee condition. Incapacitation was not recorded. On examination, the range-of-motion (ROM) was normal and pain with motion was not documented. Heel and toe walk were also normal. X-rays were recorded as normal, but the date was not reported. He was diagnosed with bilateral patellofemoral pain syndrome (PFPS) and found to not meet retention standards.

At the VA Compensation and Pension examination also performed on 26 November 2002, 6 months prior to separation, the CI reported chronic knee pain, but denied locking or instability. Incapacitation was not recorded. His gait was normal and the ROM of the knees was full without clinical findings. X-rays were normal. He was diagnosed with retropatellar pain syndrome (RPPS).

The Board considered the rating for the bilateral knee condition. The PEB rated the CI at 10% for chronic bilateral knee pain using the pain policy under the analogous code 5099-5003 (degenerative joint disease). The VA rated the knees separately, initially at 0% each, but then at 10% each, retroactive to separation. A review of the information after separation the knees were coded at 5260 (limitation in flexion).

The Board first considered if each knee was separately unfitting. It noted that the CI was consistently evaluated and treated for bilateral knee pain with neither more problematic than the other. Although the PEB rated the knees as a bilateral condition, it did not adjudicate them as separately unfitting under “combined effect.” The Board determined that the evidence supported each knee as separately unfitting. It then considered the rating. The examination of the knees was normal, the ROM normal, the gait normal, and the X-rays normal. However, the CI did have limitations in activity in pain implying painful motion; this was not present on examination though. The Board considered the codes specific for the knee and found no route to a compensable rating IAW VASRD §4.71a. It then considered the PEB code 5003, which is based on X-ray findings and non-compensable limitation in motion. Although the knee X-rays were normal, this is not uncommon with patello-femoral syndrome (PFS). (The action officer noted that PFS, PFPS, and RPPS are used interchangeably by many clinicians and refer to the same condition in this case). There was no limitation in motion on either the MEB or VA examination. 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 condition.

Contended PEB Conditions. The Board’s main charge is to assess the fairness of the PEB’s implied determination that hypertension was not unfitting. 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. The hypertension was not profiled or implicated in the commander’s statement and was not judged to fail retention standards. The CI was on no medications at the time of separation. It was reviewed by the action officer and considered by the Board. There was no performance based evidence from the record that it 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 and so no additional disability rating is 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 discussed above, PEB reliance on the USAPDA pain policy for rating the 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 and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. In the matter of the contended hypertension conditions, the Board unanimously recommends no change from the PEB determination as not unfitting. 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 20131203, 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 XXXXXXXXXXXXXX, AR20150012713 (PD201302595)


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

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