Search Decisions

Decision Text

AF | PDBR | CY2012 | PD-2012-01734
Original file (PD-2012-01734.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX       CASE: PD-2012-01734
BRANCH OF SERVICE: mARINE cORPS  BOARD DATE: 20150421
SEPARATION DATE: 20021130


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Motor Transport) medically separated for right knee condition. The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards. She was placed on limited duty and referred for a Medical Evaluation Board (MEB). Chronic knee pain” and Grade IV chondromalacia of patella, right knee, were forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. No other condition was submitted by the MEB. The Informal PEB adjudicated chronic right knee pain” as unfitting, rated 10% and noted that Grade IV chondromalacia of the patella with corresponding Grade IV chondromalacia of the lateral femoral condyle, right knee was related to the unfit condition. The CI made no appeals and was medically separated.


CI CONTENTION: Grade IV chrondromalcia - Rt Knee/Chemical Burn to Rt Hand


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 :

IPEB – Dated 20020920
VA* - (~1 Mos. Pre -Separation)
Condition
Code Rating Condition Code Rating Exam
Chronic Right Knee Pain 5299-5003 10% Residual Arthroscopic Surgery w/ Degenerative Changes Patella Right Knee 5010-5262 20% 20021022
Grade IV Chondromalacia Right Knee / Lateral Femoral Condyle Cat II
Other x 0
Other x 2 (Not in Scope)
RATING: 10%
RATING: 30%
* Derived from VA Rating Decision (VA RD ) dated 200 3 0923 (most proximate to date of separation [ DOS ] )



ANALYSIS SUMMARY:

Right Knee Condition. The evidence present for review supports that the CI had a right knee injury prior to service; however, she was asymptomatic throughout basic training and became symptomatic due to increased running at her first duty station. She also noted onset of knee locking and giving way due to pain. She was evaluated by orthopedics and treated with physical therapy (PT) and limited duty. A plain film X-ray revealed one or more bone spurs on the patella (the original report was not available for review). When her knee pain persisted, she underwent an arthroscopic procedure 7 months prior to separation. The pertinent operative findings were severe chondromalacia mainly on the lateral side of the patella and lateral femoral condyle which was down to eburnated (sclerotic) bone (note: eburnation is a change in exposed subchondral bone in degenerative joint disease in which it is converted into a dense substance with a smooth surface like ivory). Post-surgical PT did not resolve her pain and she was referred into the disability evaluation process. The narrative summary prepared 6 months prior to separation noted persistent right knee pain that began while on active duty while running inclines. At her post-operative visit, the treating orthopedic surgeon informed her that the severity of the chondromalacia of her knee joint would likely preclude her from returning to full duty. He suggested injection of the right knee with corticosteroid. He also advised that this would be a primarily palliative treatment and would not make her chronic right knee pain resolve. At the VA Compensation and Pension (C&P) exam performed a month prior to separation, the CI reported bad pain and locking and that sometimes the knee gave out. She had surgery where they found numerous bone spurs involving her right kneecap. The right kneecap was shaved, but after the operation she had not improved that much. A right knee X-ray revealed minimal degenerative change in the posterior patella.

The goniometric range-of-motion (ROM) evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Right Knee ROM (Degrees) PT ~8 Mo. Pre-Sep NARSUM ~6 Mo. Pre-Sep VA C&P ~1 Mo. Pre-Sep
Flexion (140 Normal) 140 110 130
Extension (0 Normal) 0 0 0
Comment No instability; Pos. crepitus; Normal strength Antalgic gait; Mild edema; No effusion Antalgic gait; Pos. tenderness to palpation; No effusion; No instability
§4.71a Rating 10 % 10 % (PEB 10%) 10 % (VA 20%)

The Board directed attention to its rating recommendation based on the above evidence. The PEB applied the analogous VASRD code 5299-5003 (degenerative arthritis) and rated it 10%. After a Decision Review Officer (DRO) review, the VA increased the rating to 20% for the right knee condition coded as 5010 (arthritis due to trauma) with 5262 (impairment of the tibia and fibula) effective the day after separation. With the documented right knee crepitus, antalgic gait and painful motion, the evidence easily supports the 10% evaluation under code 5003. The Board considered the operative findings of severe chondromalacia involving the patella and lateral femoral condyle along with the CI’s knee pain, buckling, and giving out as additional evidence of greater impairment than that captured by the 10% rating. That additional disability can be appropriately rated under VASRD code 5262 as applied by the VA’s DRO based on the C&P exam performed a month prior to separation. The rating levels for code 5262 are based on the subjective determination of slight (10%), moderate (20%), or marked (30%) knee disability. There was no evidence of instability or recurrent effusion that would be required for application of the marked knee disability rating. The 10% rating would confer no benefit to the CI. Additionally, VASRD §4.7 states, Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned.After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the chronic right knee pain condition.


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. The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised. In the matter of the chronic right knee pain condition, the Board unanimously recommends a disability rating of 20%, coded 5010-5262 IAW VASRD §4.71a. 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:

CONDITION VASRD CODE RATING
Chronic Right Knee Pain with related Grade IV Chondromalacia of the Patella with Corresponding Grade IV Chondromalacia of the Lateral Femoral Condyle 5010-5262 20%
COMBINED 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120811 w/atchs
Exhib
it B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record








XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review









ME MORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND
DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS
        
Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

Ref:     (a) DoDI 6040.44
(b) PDBR ltr dtd 24 Jun 15 ICO XXXXXXXXXXXXXXXXXX
(c) PDBR ltr dtd 19 Jun 15 ICO XXXXXXXXXXXXXXXXXX
(d) PDBR ltr dtd 12 May 15 ICO XXXXXXXXXXXXXXXXXX
(e) PDBR ltr dtd 9 Jun 15 ICO XXXXXXXXXXXXXXXXXX

1. Pursuant to reference (a) I approve the recommendations of the Physical Disability Board of Review set forth in references (b) through (e).

2. The official records of the following individuals are to be corrected to reflect the stated disposition:

a.      
XXXXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability severance pay with a disability rating of 20 percent (increased from 10 percent) effective date of discharge.

b. XXXXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability severance pay with a disability rating of 20 percent (increased from 10 percent) effective date of discharge.

c. XXXXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effective date of discharge.

d. XXXXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability severance pay with a disability rating of 10 percent (increased from 0 (zero) percent) effective date of discharge.

3. Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are complete.



XXXXXXXXXXXXXXXXXXXX
Assistant General Counsel
(Manpower & Reserve Affairs)

Similar Decisions

  • AF | PDBR | CY2011 | PD2011-00123

    Original file (PD2011-00123.docx) Auto-classification: Approved

    The PEB adjudicated “left knee pain with grade II chondromalacia” condition as unfitting, rated 10%, with application of the VA Schedule for Rating Disabilities (VASRD) and possible application of the US Army Physical Disability Agency pain policy and DoDI 1332.39. Left Knee Condition . MEMORANDUM FOR Commander, US Army Physical Disability Agency

  • AF | PDBR | CY2012 | PD2012 01179

    Original file (PD2012 01179.rtf) Auto-classification: Denied

    RATING COMPARISON : ServiceIPEB – Dated 20030221VA -( 2 weeks Pre-Separation)ConditionCodeRatingConditionCodeRatingExam Bilateral Medial Tibial Plateau Stress FractureR-5003-5262 L-5003-526210% 0%Stress Fracture, Lt. Medial Tibial Plateau and FemoralCondyle526220%*20030303Bilateral Medial Femoral Condyles Stress FractureCAT IIIStress Fracture, Right. It is noted for the record that the Board is subject to the same laws for disability entitlements as those under which the Disability...

  • AF | PDBR | CY2013 | PD-2013-01228

    Original file (PD-2013-01228.rtf) Auto-classification: Denied

    The knee condition, characterized as “chronic right knee pain secondary to severe chondromalacia patella”was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.No other conditions were submitted by the MEB.The Informal PEB adjudicated “chronic right knee pain” as unfitting, rated 10%with likely application of the VA Schedule for Rating Disabilities (VASRD). The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available...

  • AF | PDBR | CY2011 | PD2011-01061

    Original file (PD2011-01061.docx) Auto-classification: Denied

    The FPEB convened 26 April 2007 and after reviewing newly provided medical documents, adjudicated the right knee chondromalacia osteoarthritis of the medial compartment as unfitting, rated 10% with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD). In January 2005 surgical arthroscopy was performed on the knee revealing right knee chondromalacia of the patella with lateral patellar mal-tracking and chondromalacia of the medial femoral condyle and lateral tibial...

  • AF | PDBR | CY2013 | PD 2013 01065

    Original file (PD 2013 01065.rtf) Auto-classification: Approved

    RATING COMPARISON : Service IPEB – Dated 20040505VA - (~ 4.5 Mos Pre-Separation)ConditionCodeRatingConditionCodeRatingExam Chronic Bilateral Knee Pain5099-500310%Degenerative Joint Disease Left Knee501010%20040415Degenerative Joint Disease Right Knee501010%20040415Residual Scarring Left Knee Surgeries780410%20040415No Additional MEB/PEB EntriesOther x 520040415 Combined: 10%Combined: 80% *Derived from VA Rating Decision (VARD) dated 20040910 (most proximate to date of separation (DOS))...

  • AF | PDBR | CY2013 | PD-2013-01978

    Original file (PD-2013-01978.rtf) Auto-classification: Denied

    No other conditions were submitted by the MEB.The Informal PEB adjudicated “bilateral anterior knee pain” as unfitting, rated 10%. The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of theVeterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. The examiner recommended an NSAID, continued use of a splint, aggressive PT and Hyalgen...

  • AF | PDBR | CY2013 | PD2013 00272

    Original file (PD2013 00272.rtf) Auto-classification: Denied

    The PEB adjudicated the condition as right knee pain rated from arthritis, due to trauma while in Iraq; soldier had undergone a right knee arthroscopic medial meniscal repair and microfracture of the medial femoral condyle, and a right knee HemiCap procedure,as unfitting, rated 10% with likely application of Veterans Affairs Schedule for Rating Disabilities (VASRD).The CI made no appeals and was medically separated. RECOMMENDATION : The Board, therefore, recommends that there be no...

  • AF | PDBR | CY2014 | PD-2014-01090

    Original file (PD-2014-01090.rtf) Auto-classification: Denied

    The Informal PEB (IPEB) adjudicated “bilateral medial tibial stress fracture” as unfitting, rated 20%, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). invalid font number 31502 SAF/MRB 1500 West Perimeter Road, Suite 3700 Joint Base Andrews, MD 20762Dear XXXXXXXXXXXXXXXXXXXX:Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-01090.After careful consideration of your application and...

  • AF | PDBR | CY2013 | PD-2013-01337

    Original file (PD-2013-01337.rtf) Auto-classification: Approved

    Post-Separation)ConditionCodeRatingConditionCodeRatingExam Left Hip and Bilateral Knee pain5099-50030%Residuals, Left Hip Stress Fracture5099-501010%20011212Right Knee Chondromalacia5099-501010%20011212Left Knee Chondromalacia5099-501010%20011212Other MEB/PEB Conditions x 0 (Not In Scope)Other x 2 RATING: 0%RATING: 30% *Derived from VA Rating Decision (VARD)dated 20020708(most proximate to date of separation(DOS)) Left Hip and Bilateral KneePain .This CI entered the Army in May 1999. ...

  • AF | PDBR | CY2012 | PD-2012-01921

    Original file (PD-2012-01921.rtf) Auto-classification: Denied

    The MEB also identified and forwarded history of cellulitis, left knee, chronic bilateral hip pain secondary to bilateral iliotibial band friction syndrome, chronic mechanical low back pain, mild (less than a centimeter) left shorter than right limb length discrepancy, and mild bilateral pes planus conditions.The PEBadjudicated “left patellofemoral pain with secondary chronic left knee pain” as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating...