RECORD OF PROCEEDINGS
PHYSICAL DISABILITY REVIEW BOARD
NAME: BRANCH OF SERVICE: AIR FORCE
CASE NUMBER: PD0900095 COMPONENT: ACTIVE
BOARD DATE: 20090610 SEPARATION DATE: 20070425
________________________________________________________________
SUMMARY OF CASE: This covered individual (CI) was an NCO medically separated from the Air Force in 2007 after 6 years of service. The medical basis for the separation was a torn hamstring muscle sustained as a sports injury in 2004. He developed progressive pain and swelling, and was treated conservatively during the balance of his duty tour in Germany. He persisted with significant pain and duty profiles on return to CONUS, resulting in a MEB evaluation. His condition was deemed permanent and inoperable. He was referred to the PEB, found unfit and separated at 10% disability. He received an initial 10% rating by the VA eight months after separation, which was raised to 40% a year later. Although there is a question as to whether the increase by the VA was partly on the basis of worsening, the rating increase ensued after submission to the VA of medical documentation dated concurrently with the MEB process and prior to PEB adjudication. This specifically included a civilian functional evaluation obtained by the Air Force, which demonstrated impairment of the hamstring muscle group which the VA referenced in its 40% rating decision. The CI has submitted an appeal to the VA to apply the 40% rating to the time of separation, and contends to the PDBR that the severity of his impairment warranted a higher PEB rating as well.
______________________________________________________________
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 PDBR to the extent they were inconsistent with the VASRD in effect at the time of the adjudication. Although rating rationales were not elaborated, it would appear that the PEB relied solely on the VASRD for its rating. The coding of the muscle injury was consistent between the PEB and both VA ratings. The Board applied the rating criteria elaborated in §4.56 of the VASRD for Group XIII muscle injuries, appropriate to this case. Evaluation was based solely on documented medical findings which preceded the PEB adjudication. The Board medically opines that the disparity between VA ratings of 2007 and 2008 is unlikely to be heavily attributable to the progression of severity of a chronic injury dating to 2004. The §4.56 rating criteria are more specific for penetrating combat-type trauma. Many of the elements elaborated are, therefore, not applicable to this CI’s type of injury and were disregarded. Of the applicable rating criteria, this injury more than meets all of the possible criteria for the Moderate (10%) rating applied by the PEB. Available documentation supports four of six possible criteria for the Moderately Severe (30% rating), and three of eight possible criteria for the Severe (40%) rating. The 40% rating, however, entails a more severe functional impairment than would appear to characterize the CI’s condition at separation. The Board judged unanimously that the 30% rating was most appropriate and that the mild 10% PEB rating could not be equitably justified under VASRD criteria.
______________________________________________________________
RECOMMENDATION: The Board therefore recommends that the CI’s prior determination be adjusted as follows, effective as of the date of his prior medical separation.
| Unfitting Condition | VASRD Code | Rating |
|---|---|---|
| Residuals, L hamstring rupture | 5313 | 30% |
| Combined | 30% |
________________________________________________________________
The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20090130, w/atchs.
Exhibit B. Service Treatment Record.
Exhibit C. Department of Veteran's Affairs Treatment Record.
President
Physical Disability Board of Review
SAF/MRB
1535 Command Drive, Suite E-302
Andrews AFB, MD 20762-7002
Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2009-00095.
After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was not appropriate under the guidelines of the Veterans Administration Schedule for Rating Disabilities. Accordingly, the Board recommended your separation be recharacterized to reflect disability retirement, rather than separation with severance pay.
I have carefully reviewed the evidence of record and the recommendation of the Board. I concur with that finding, accept their recommendation and determined that your records should be corrected accordingly. The office responsible for making the correction will inform you when your records have been changed.
As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP). Upon receipt of this letter, you must contact the Air Force Personnel Center at 1-800-531-7502 to make arrangements to obtain an SBP briefing prior to rendering an election. If a valid election is not received within 30 days from the date of this letter, you will not be enrolled in the SBP program. Unless at the time of your separation, you were married or had an eligible dependent child, in such a case, failure to render an election will result in automatic enrollment.
Director
Air Force Review Boards Agency
Attachment:
Record of Proceedings
cc:
SAF/MRBR
DFAS-IN
AF | PDBR | CY2010 | PD2010-00719
His treatment included medications, physical therapy, subacromial and nerve root injections, and three arthroscopic surgeries, without significant improvement. The PEB rated the shoulder condition as a muscle injury IAW §4.73, while the VA used §4.71a to rate the condition for impairment of the clavicle or scapula. These conditions likely contributed to the CI’s overall shoulder impairment, however, and are considered in the Board’s recommendations.
AF | PDBR | CY2013 | PD-2013-02563
Right Foot/Lower ExtremityCondition (Heel Spur, Plantar Fasciitis, Hammer Toe,Achilles and Gastroc-Soleus Tendinitis) .The service treatment record (STR) contains a routine exam entry from 1997 (same year as enlistment) documenting hallux valgus (bunion deformity of the big toe); and, a clinic note from the same year noting a 4-month history of bilateral foot pain. The PEB rated the right foot condition analogously under 5279 (metatarsalgia) which provides for a maximum rating of 10%, under...
AF | PDBR | CY2009 | PD2009-00156
In the matter of the cervical shrapnel injury and whiplash condition, the Board unanimously recommends that it be rated for two separate unfitting conditions as follows: injury to muscle group XXII coded 5322 and rated 10%; and, injury to muscle group XXIII coded 5323 and rated 10%; both IAW VASRD §4.56 and §4.73. In the matter of the right wrist condition, history of low back pain, headache condition or any other medical conditions eligible for Board consideration; the Board unanimously...
AF | PDBR | CY2013 | PD-2013-01204
The record contains well documented evidence of significant left thigh muscle injury with an open, comminuted femur fracture that required ORIF and subsequent bone grafting. RECOMMENDATION : The Board recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be recharacterized to reflect permanent disability retirement, effective as of the date of his prior medical separation: DoD Physical Disability Board of Review
AF | PDBR | CY2011 | PD2011-00852
The Board must apply separate codes and ratings in its recommendations if compensable ratings for each condition are achieved IAW the VASRD. In the matter of the left elbow tendonitis condition, the Board unanimously recommends a service disability rating of 10%, coded 5099-5024 IAW VASRD §4.71a. The pertinent military records of the Department of the Air Force relating XXXXX, be corrected to show that the diagnosis in his finding of unfitness was Tricep Tenonitis Left Elbow, VASRD Code...
AF | PDBR | CY2011 | PD2011-00790
Left Thigh Muscle Condition . All members agreed that the thigh muscle injury and open comminuted fracture of the femur with IM rod and nails was an integral part of the CI’s injury and disability that rendered the CI incapable of continued service within his MOS; and, accordingly merits a separate service rating. Painful Thigh Scars Condition .
AF | PDBR | CY2014 | PD-2014-03671
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. It records 4/5 quadriceps strength, notes that the CI was able to perform 20 straight leg raises, and contains the entry “tenderness to palpation mid-quad muscle belly; area of hardness – probable scar tissue.” There...
AF | PDBR | CY2011 | PD2011-00502
The PEB adjudicated the GSW to the right thigh condition as unfitting, rated 0%, with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD). The VA rated this exam as 5314 at 30%. The crucial difference in rating was the selection of disability codes; the military coded the CI’s thigh GSW based on a knee ROM disability code of 5261 for non-compensable decreased knee extension; however, the VA rated the CI under disability code 5314 for muscle injury.
AF | PDBR | CY2013 | PD 2013 00656
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. At the MEB narrative summary performed on 14 Jan 2005 (8 months prior to separation) she endorsed a painful left shoulder with overhead activities with feelings of dislocations when reaching for a seatbeltor taking items out of the refrigerator.The examination revealed...
AF | PDBR | CY2011 | PD2011-01101
An additional combined condition, “secondary low back and bilateral knee pain” was forwarded as “not boardable.” The PEB (via an Informal Reconsideration following an appeal) conceded aggravation of the congenital podiatric conditions; and, consolidated three of the MEB submitted conditions (as specified in the PEB’s DA Form 199 language quoted below) as a single unfitting condition characterized as “Painful feet on [sic] ankles due to plantar fasciitis and posterior tibial tendonitis with...