RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW
NAME: BRANCH OF SERVICE: army
CASE NUMBER: PD0900117 BOARD DATE: 20090714
SEPARATION DATE: 20071102
________________________________________________________________
SUMMARY OF CASE: This covered individual (CI) was an E-5 Food Service Specialist medically separated from the Army in 2007 after 6 years of service. The medical basis for the separation was bilateral knee pain with full active range of motion (ROM). CI injured his knees in Iraq when a water trailer tongue fell onto his knees. Medical treatment did not resolve CI’s bilateral knee pain, and CI reasonably declined surgery. CI was referred to the PEB, found unfit and separated at 0% disability. The VA initially rated each of CI’s knees separately at 10% each, obstructive sleep apnea (OSA) at 50%, and Pseudofolliculitis at 30% for a combined 70% rating. The VA later diagnosed and rated PTSD at 30% (exam 20080707, rating 20081014) for a new combined rating of 80%. The CI contends for a higher rating as he ‘was mentally unstable at the time’ of his medical board, ‘was misdiagnosed by mental health doctors,’ ‘was diagnosed with Post Traumatic Stress Disorder (PTSD) from the VA’ and has an overall rating of 80% from VA and 0% from the Army and receives Social Security for his PTSD.
COMPARISON OF VA AND DISABILITY RATINGS:
| Previous Determinations | |
|---|---|
| Service (PEB) | VA Initial Rating via BDD |
| PEB Condition | Code |
| Bilateral knee pain with full active ROM. | 5099-5003 |
| OSA | - |
| Restless leg syndrome | - |
| TOTAL Combined: 0% | TOTAL Combined (incl non-PEB Dxs): 70% original; Later to 80% |
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. Both OSA and restless leg syndrome were specifically addressed by the PEB as not unfitting and that determination is well supported. The record did not support adding either of those conditions as unfitting. The Army pain rule was likely applied in rating bilateral knee pain at 0% under a single VASRD code at 0%. The VA rated the left knee at 10% and the right knee at 10% using slightly different codes. The Board determined that separately rating each knee due to painful motion (IAW §4.59 Painful motion) at 10% each was the predominate application of the VASRD absent the pain rule. Although the pathology of each knee was slightly different, there was no benefit to the CI of changing the original VASRD codes used by the Army versus adopting the VA’s knee coding.
CI was not diagnosed with PTSD during service. No active psychiatric condition is mentioned in the NARSUM or PEB. The MEB exam (20070806) mentions 6 counseling sessions early in 2001 and an S1 profile. The CI’s original VA rating determination from pre-discharge application did not address or rate any anxiety disorder, depression, or PTSD-like symptoms. PTSD was diagnosed by the VA based on examination of 20080707 (8 months post discharge). The VA linked PTSD to stressor(s) in Iraq of another division Soldier dying of IED injuries. VA noted STR’s indicated a diagnosis of adjustment disorder with anxiety NOS in Feb 2007 and atypical depressive disorder in Aug 2007. In Mar 2008 CI had a post service treatment record VA diagnosis of adjustment disorder with anxiety and systemic disorder that was changed to a diagnosis of PTSD in May 2008. Even were a diagnosis of PTSD present at the time of discharge, it was not evaluated as part of CI’s disability evaluation. Accordingly the issue of whether to add PTSD as an unfitting diagnosis is beyond the scope of this board (but can of course be addressed by the CI’s Service Board for Corrections).
The Board unanimously voted to rate each knee separately at 10% and not to add any other unfitting condition(s).
RATIONALE: Adding or denying PTSD as an unfitting diagnosis was beyond the scope of this Board. No other diagnosis rose to the unfitting level. Both knees were determined as unfitting by the original PEB and had painful motion, therefore §4.59 Painful motion led to separately rating each knee.
________________________________________________________________
RECOMMENDATION: The Board recommends that the CI’s prior separation be modified from 0% to a 20% rating as indicated below.
| Unfitting Condition | VASRD Code | Rating |
|---|---|---|
| Right knee, painful motion | 5099-5003 | 10% |
| Left knee, painful motion | 5099-5003 | 10% |
| COMBINED | 20% |
________________________________________________________________
The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20090202, w/atchs.
Exhibit B. Service Treatment Record.
Exhibit C. Department of Veteran's Affairs Treatment Record.
AF | PDBR | CY2009 | PD2009-00053
The medical basis for the separation was bilateral shoulder and knee joint conditions and a back condition. The Board agrees with the CI that the VA diagnosis of PTSD was more appropriate to his condition, but cannot make a recommendation for additional rating since the condition was not unfitting for continued military service. In the matter of the elbow condition, neck condition and all of the CI’s other medical conditions; the Board unanimously agrees that it cannot recommend a finding...
AF | PDBR | CY2012 | PD2012-00414
The PEB adjudicated the bilateral knee chondromalacia with bilateral knee pain condition as unfitting, rated 20%, with 10% assigned for each knee and with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). No actual Axis I mental health diagnosis was made and the examiner noted the CI no longer had any significant depressive symptoms at all. Although they used different VASRD codes, both the PEB and the VA rated each knee at 10% based on painful motion.
AF | PDBR | CY2012 | PD2012 00922
5099-5003Right Knee PFS5099-50240%20050108 The PEB combined the right knee chronic knee pain due to PFS and left knee chronic knee pain due to PFS conditions under a single disability rating, coded analogously to 5003 and rated IAW the USAPDA pain policy.The Board,IAW VASRD §4.7 (higher of two evaluations), must consider separate ratings for PEB bilateral joint adjudications; although, separate fitness assessments must justify each disability rating. BOARD FINDINGS : IAW DoDI 6040.44,...
AF | PDBR | CY2009 | PD2009-00024
CI was referred to the PEB, found unfit for bilateral knee pain only and was separated at 0% disability. This contradicts CI’s petition of being ‘rated for asthma’ as the PEB clearly found CI ‘Fit for Duty’ and did not rate CI’s Asthma. The Board determined to rate each knee separately at 10% (with bilateral factor) using painful motion with the PEB codes, and to deny adding any other condition as unfitting.
AF | PDBR | CY2014 | PD-2014-00094
SEPARATION DATE: 20040322 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. Providing a correction to the individual’s separation document showing that the individual was separated by reason of permanent disability retirement effective the date of the original...
AF | PDBR | CY2014 | PD-2014-02055
At an Orthopedic follow-up visit 7 March 2007 the CI reported bilateral anterior knee pain and the exam noted patellofemoral tenderness with full motion of both knees, without effusion or instability. In the matter of the bilateral knee condition the Board recommends disability rating as follows: an unfitting right knee condition, rated 10% and an unfitting left knee condition rated 0% both coded 5299-5260 IAW VASRD §4.71a.In the matter of the contended anxiety disorder condition, the Board...
AF | PDBR | CY2013 | PD 2013 00582
A new MEB was done and identified and forwarded generalized anxiety disorder and alcoholdependence as medically acceptable.The Informal PEBadjudicated chronic bilateral knee pain, chronic back pain, due to DDD, without neurologic abnormality and sensorineural hearing loss as unfitting, rated 10%, 10%, and 0%respectively, citing the US Army Physical Disability Agency (USAPDA) pain policyand the VA Schedule for Rating Disabilities (VASRD).The remaining conditions were determined to be not...
AF | PDBR | CY2014 | PD-2014-00878
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. At the VA Compensation and Pension (C&P) exam performed 2 monthsprior to separation, the CI reported 6/10 pain with weakness, stiffness, fatigability, locking, and swelling of both knees; with giving out of the right...
AF | PDBR | CY2009 | PD2009-00054
The medical basis for the separation was chronic low back pain (LBP) and multiple painful joints (Bilateral degenerative joint disease [DJD] of hips and knees as well as the left ankle) without any history of trauma. NARSUM (date 20020917): CHIEF COMPLAINT: This is a 26-year-old male with two-year history of bilateral shoulder pain, back pain, bilateral hip pain, bilateral knee pain left greater than right, and left ankle pain. The MEB diagnosis #1 (Medically Unacceptable) described...
AF | PDBR | CY2011 | PD2011-00833
The PEB adjudicated the “chronic neck, back, shoulder, knee, tibial, hip and shoulder pain” as a single unfitting condition rated at 20% with specified application of the USAPDA pain policy; and adjudicated the OSA condition as unfitting, rated 0% with application of DoDI 1332.39. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), in regards to the chronic neck, back, knee, tibia, hip, shoulder pain joint conditions combined under a single...