RECORD OF PROCEEDINGS

PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXX BRANCH OF SERVICE: Army

CASE NUMBER: PD1100438 SEPARATION DATE: 20030311

BOARD DATE: 20120307

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty member, SSG/E6, 31F, Network Switching Systems Operator, medically separated for right knee pain post arthroscopy and partial menisectomy. She did not respond adequately to treatment and was unable to perform within her Military Occupational Specialty (MOS) or meet physical fitness standards. She was issued a permanent L3 profile and underwent a Medical Evaluation Board (MEB). Degenerative joint disease of the right knee was forwarded to the Physical Evaluation Board (PEB) as medically unacceptable IAW AR 40-501. No other conditions appeared on the MEB’s submission. Other contended conditions are included in the Disability Evaluation System (DES) packet will be discussed below. The PEB adjudicated the right knee condition as unfitting, rated 10%, with application of the Department of Defense Instruction (DoDI) 1332.39 and Veterans’ Administration Schedule for Rating Disabilities (VASRD), respectively. The CI made no appeals, and was medically separated with a 10% disability rating.

CI CONTENTION: “Disability rating was increased by VA for for left carple tunnel syndrome went from 0% disabilty from the Army to 10% VA. Right Carpal carpal tunnel syndrome is 10% per VA rating system. Post compression fractures of T2-T5 of 10% as per VA and lastly post operative residuals degenerative joint disease, right knee is 10%.”

RATING COMPARISON:

ANALYSIS SUMMARY: The Military Services, by law, can only rate and compensate for those conditions that were found unfitting for continued military service based on the severity of the condition at the time of separation and not based on possible future changes. However, the Department of Veterans’ Affairs (DVA), operating under a different set of laws, can rate and compensate all service-connected conditions without regard to their impact on performance of military duties, including conditions developing after separation that are direct complications of a service-connected condition. The DVA can also increase or decrease ratings based on the changing severity of each condition over time. The Board’s role is confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations compared to VASRD standards, as well as the fairness of PEB fitness adjudications at the time of separation. The Board’s threshold for countering DES 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.

Right Knee Condition: There were two goniometric range-of-motion (ROM) evaluations in evidence, with documentation of additional ratable criteria, which the Board weighed in arriving at its rating recommendation. Although the VA Compensation and Pension (C&P) examiner did not provide ROM measurements, he indicated that the ROM was full, which implies 0-140 degrees.

* Conceding §4.59 (painful motion) or §4.40 (functional loss)

The CI underwent arthroscopic surgery of the right knee with a partial meniscectomy in August 2000. Intraoperative findings included degenerative changes (chrondromalacia) of the lateral tibia. The CI had persisting right knee pain preventing vigorous physical activities, particularly running. The PEB and VA chose different coding options for the condition, both of which were appropriate for the CI’s pathology, and both of which led to equivalent disability ratings. The PEB rated the knee under the VASRD coded 5003, degenerative arthritis. Radiographic evidence and surgical observations would support that approach. The VA rated the knee using the code for tibia and traumatic arthritis (5262-5010) in the absence of a compensable ROM impairment or evidence of instability. Both of these approaches allowed for a compensable rating without relying on the joint codes premised on ROM impairment. ROMs were in the 0% range, although evidence supporting the minimum compensable ratings IAW §4.59 or §4.40 (as cited in the chart) can be readily drawn from the records. The only approach to a higher rating which is countenanced by VASRD §4.71a would be to entertain the 5258 code (cartilage, semilunar, dislocated, with frequent episodes of “locking,” pain, and effusion into the joint) which allows for a 20% rating. Neither the MEB examiner, nor the VA examiner documented that the CI had frequent episodes of locking or effusions in the knee and there was no evidence of dislocated meniscus following surgical meniscectomy. Likewise, records provided no evidence of instability. In fact, the commander’s statement clearly indicated that CI was able to perform all aspects of her duties including climbing stairs every day. The commander indicated that CI’s only limitation was running. Furthermore, the C&P report dated 27 January 2003 clearly indicated that CI’s exercise routine consisted of 30 minutes elliptical and 30 minutes weight lifting four to five times a week. There is not reasonable doubt in the CI’s favor, therefore, to justify a Board recommendation for other than the 10% rating assigned by the PEB for the right knee condition.

Other Contended Conditions. The CI’s application asserts that compensable ratings should be considered for left carpal tunnel syndrome, right carpal tunnel syndrome, and compression fracture of vertebrae T2-5. The CI was evaluated in 2001 for complaints of hand numbness suggestive of ulnar neuropathy, not carpal tunnel syndrome. Electrodiagnostic testing in 2001 (EMG and NCV) was normal, showing no evidence for ulnar or median neuropathy, or radiculopathy (T1-L5). At the time of the MEB examination, the CI reported occasional numbness in her hands on the DD Form 2807. The VA examination documented sensitivity to the Tinel’s test suggestive of carpal tunnel syndrome however, narrative summary (NARSUM) and C&P examinations documented intact strength and sensation of both hands and upper extremities.

The CI injured her back in a fall during training in 1995 (eight years before separation). X-ray and bone scan examinations were consistent with mild compression fractures of T3 and T4 vertebrae. An MRI in 1996 showed evidence of a mild compression of T3 only. Following recovery, CI presented for care of intermittent complaints of back pain, and a P2 profile from December 2000 is in the record. However CI satisfactorily performed her duties and subsequent profile reports do not list the back condition. Although a NARSUM dated 11 April 2001 recorded paraspinous muscle spasms with decreased range of motion, a clinic encounter on 7 May 2002 for leg pain after playing softball records no complaint of back pain at that time. The commander’s letters in July 2002 and September 2002 reflect limitation in running but otherwise excellent duty performance and daily physical training. The VA C&P examination on 27 January 2003 recorded CI report of occasional pain between the shoulder blades from excessive writing, typing, desk work or lifting. On examination, the gait, posture and spinal contour were normal. The spine was non-tender with full ROM. Strength, reflexes and sensation were normal. The examiner concluded there was no functional impairment at that time. X-rays three years after separation noted slight wedging at the T3 vertebra. All of these conditions were reviewed by the action officer and considered by the Board. There was no evidence for concluding that any of the conditions interfered with duty performance to a degree that could be argued as unfitting. The Board determined therefore that none of the stated conditions were subject to service disability rating.

Remaining Conditions. Other conditions identified in the DES file were sore joints in fingers, history of finger fractures (in service and EPTS), bilateral osteoarthritis of the knees, history of knee surgery on the left knee at age 16 (EPTS), costochondritis, and history of depression, treated, resolved. None of these conditions were clinically or occupationally significant during the MEB period, none carried attached profiles and none were implicated in the commander’s statement. These conditions were reviewed by the action officer and considered by the Board. It was determined that none could be argued as unfitting and subject to separation rating. Additionally, cervical dysplasia was noted in the VA rating decision proximal to separation, but was not documented in the DES file. The Board does not have the authority under DoDI 6040.44 to render fitness or rating recommendations for any conditions not considered by the DES. The Board, therefore, has no reasonable basis for recommending any additional unfitting conditions for separation rating.

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. In the matter of the right knee condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication at separation or permanently. In the matter of carpal tunnel syndrome, and thoracic spine compression fractures, the Board unanimously agrees that it cannot recommend a finding of unfit for additional rating at separation. In the matter of the left knee arthritis, sore joints in fingers, or any other medical conditions eligible for Board consideration, the Board unanimously agrees that it cannot recommend any findings of unfit for additional rating at separation.

RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows:

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20110408, w/atchs

Exhibit B. Service Treatment Record

Exhibit C. Department of Veterans' Affairs Treatment Record

XXXXXXXXXXXXXXXXXXXX

President

Physical Disability Board of Review

SFMR-RB

MEMORANDUM FOR Commander, US Army Physical Disability Agency

(TAPD-ZB / ), 2900 Crystal Drive, Suite 300, Arlington, VA 22202

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXX, AR20120004761 (PD201100438)

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 XXXXXXXXXXXXXXXXXXXX

Deputy Assistant Secretary

(Army Review Boards)

CF:

( ) DoD PDBR

( ) DVA