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AF | PDBR | CY2012 | PD2012 00916
Original file (PD2012 00916.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    BRANCH OF SERVICE: Army
CASE NUMBER: PD1200916   SEPARATION DATE: 20030303
BOARD DATE: 20130329


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (11B/Infantryman), medically separated for status post (s/p) excision of bilateral Osgood-Schlatter ossicles. The CI sustained an initial knee injury in May 2001 carrying furniture at the barracks on post; his knees buckled forward and gave way. A painful condition in both knees developed. Despite treatment to include surgery, this condition did not adequately improve to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). “Bilateral Osgood-Schlatter’s disease, status post tibial tubercle excisions, moderate was forwarded by them MEB as unfitting to the PEB IAW AR 40-501.” Low back pain (LBP), dorsal wrist ganglion, mild and hypothyroidism, moderate conditions, identified in the rating chart below, were also identified and forwarded by the MEB. The Physical Evaluation Board (PEB) adjudicated the bilateral knee conditions as unfitting, rated 0%, with likely application of Veterans Affairs Schedule for Rating Disabilities (VASRD). The remaining conditions were determined to be not unfitting. The CI made no appeals, and was medically separated with a 0% disability rating.


CI CONTENTION: “prior service profiles were not looked at for complaints of knee pain nothing was ever done about my complaints about ptsd from somalia until I went to the VA 11 or 12 years later no documentation nothing! Haven’t been able to hold steady work, for many years, family life sucks can’t take long walks without knees hurting for days afterwords. Not saying any of this is yalls fault or that you can fix any of it but it seems like enlisting in 91 was the wort day of my life, and has any of ya’ll looked into lariaum Toxic problem from the pills we took in Somalia maybe its that and not PTSD.”


SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2) is limited to those conditions which were determined by the PEB to be specifically unfitting for continued military service; or, when requested by the CI, those condition(s) “identified but not determined to be unfitting by the PEB.” The ratings for unfitting conditions will be reviewed in all cases. The bilateral Osgood-Schlatter ossicles condition as requested for consideration meet the criteria prescribed in DoDI 6040.44 for Board purview and is addressed below. The remaining contended conditions (posttraumatic stress disorder [PTSD], and lariaum toxic) are not within the Board’s purview. Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Army Board for Correction of Military Records.
RATING COMPARISON:

Service IPEB – Dated 20030114
 VA (~2 Mos. Post-Separation) – All Effective Date 20030304
Condition
 Code Rating Condition Code Rating Exam
Bilateral O sgood - S chlatter Ossicle
5099-5003 0% Degenerative Joint Disease, Bilateral Knee 5010 10% 20030522
Low Back Pain
Not unfitting Degenerative Disc Disease, Lumbar Spine 5295 0% 20030522
Dorsal Wrist Ganglion, Mild
Not unfitting Ganglion Cyst, Left Wrist 7819 0% 20030522
Hypothyroidism , Moderate
N ot unfitting No VA Entry
↓No additional MEB / PEB entries↓
 Tinnitus 6260 10% 20030528
Not Service-Connected x 2
Combined: 0%
 Combined: 20%

* PTSD was awarded at 30% eff 20060811 on VARD 20080412 for a combined total of 40%.

ANALYSIS SUMMARY: The Board acknowledges the sentiment expressed in the CI’s application regarding the significant impairment with which his service-incurred condition continues to burden him. It is a fact, however, that the Disability Evaluation System (DES) has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation. This role and authority is granted by Congress to the Department of Veterans Affairs (DVA).

Bilateral knee condition. The MEB noted bilateral knee pain since May 2001 that occurred after climbing stairs carrying furniture. He later reported knee gives away with pain in both knees that started over the tibial tubercles. In February 2002, a bone suggested bilateral Osgood-Schlatter’s disease. In April 2002, the CI underwent excision of right tibial tubercle for the diagnosis of bilateral Osgood-schlatter’s disease of the right knee, and a second similar surgery on the left knee in August 2002. Orthopedic examination, 6 June 2002, revealed minimal pain and full weight bearing capability. On PT evaluation, 7 June 2002, CI reported walking up to a mile without pain and only mild swelling. Physical examination revealed full range-of-motion (ROM), with normal strength bilaterally. At no point prior to the narrative summary (NARSUM) did the CI report locking, snapping, or give away of the knees and has had only mild swelling. The commander’s statement, 12 September 2002, indicated the CI was not able to perform his job as an infantry soldier, due to physical limitations, and had been a solid performer despite his diminished capabilities. His profile allowed him to walk and run at own pace and distance (23 December 2002). At the MEB NARSUM evaluation, 7 October 2002; 5 months, prior to separation, the CI reported no significant changes in pain in spite of surgery. On examination, gait was normal, no effusion, tenderness noted over the tibia and some mild medial joint line tenderness over the right knee. There was full ROM to 135 degrees of motion, bilaterally. There was no evidence of instability. At the VA Compensation and Pension (C&P) examination, 22 May 2003, approximately 2 months after separation, the CI reported he is unemployed, takes no medication on a regular basis, utilizes no assistive mobility devices, and he still has pain in both knees. On examination, his gait was normal and he had full ROM, no effusion, and mild tenderness on palpation with no evidence of joint instability in either knees.

The Board directs attention to its rating recommendation based on the above evidence. The PEB rated the condition at 0% under the analogous code 5099-5003 (degenerative arthritis) citing full ROM, stable. The VA rated the condition at 10% code 5010 (traumatic arthritis) based on painful or limited motion. A higher rating of 20% under 5010 requires occasional incapacitating exacerbations not supported by the record in evidence. The Board undertook to rate the individual right and left knee conditions. The Board unanimously agreed that neither knee was compensable IAW §4.71a for ROM or instability, and therefore, unbundling was of no benefit to CI. The Board unanimously agreed neither knee rose to a level of compensability under §4.59 or §4.40. The Board was unable to find any additional codes for consideration. 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 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. In the matter of the bundled bilateral knee condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. There were no other conditions within the Board’s scope of review for consideration.


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

UNFITTING CONDITION
 VASRD CODE RATING
Bilateral knee, degenerative knee disease s/p excision of bilateral Osgood-Schlatter ossicles
 5099-5003 0%
COMBINED
 0%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120611, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




        
         Physical Disability Board of Review


SFMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD-ZB),

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for AR20130009070 (PD201200916)


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                                                 
                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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