Search Decisions

Decision Text

AF | PDBR | CY2012 | PD2012 01789
Original file (PD2012 01789.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX        CASE: PD1201789
BRANCH OF SERVICE: Army         BOARD DATE: 20140318
SEPARATION DATE: 20030617


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (77F/Petroleum Supply Specialist) medically separated for chronic bilateral knee pain. The CI first reported left knee pain in basic training. He was subsequently reclassified from 11B (Infantry) to his current Military Occupational Specialty (MOS). The right knee became symptomatic in 2002. Neither could be adequately rehabilitated to meet the physical requirements of his MOS nor satisfy physical fitness standards. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The MEB forwarded “bilateral patella-femoral arthrosis; s/p bilateral lateral retinacular release” to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded six other conditions (see rating chart below) for PEB adjudication as meeting retention standards. The PEB adjudicated “chronic bilateral knee pain secondary to bilateral patella-femoral arthrosis, s/p bilateral lateral retinacular release” as unfitting, rated 0% with application of the VA Schedule for Rating Disabilities (VASRD). The six remaining conditions were determined to be not unfitting . The CI made no appeals and was medically separated.


CI CONTENTION: The CI writes: “VA awarded service connected disabilities in excess of 100% and a combined disability rating of 70% due to disabilities received during service.”


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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI. The rating for the unfitting bilateral knee condition is addressed below. Based on the CI’s contention, nasal septal deviation, ingrown toenail, right ring finger, low back pain (LBP), tinnitus/hearing loss (HL) and right wrist pain conditions are within the DoDI 6040.44 defined purview of the Board. 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 Board for Correction of Military Records.


RATING COMPARISON :

Service IPEB – Dated 20030407
 VA - (7 Mos. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Bil Knee Pain
 5099-5003 0% S/P Lat Release for PFPS, R Knee 5260 10% 20021206
S/P Lat Release for PFPS, L Knee 5260 10% 20021206
Nasal Septal Deviation Not Unfitting S/P Open Septal Rhinoplasty… 6502 0% 20021203
R Great Toe, Ingrown Toenail, S/P Removal Not Unfitting Ingrown Toenail, Right Great Toe 5276 NSC 20021206
R Ring Finger, Decreased ROM, S/P Laceration Not Unfitting Scar, S/P Z-plasty for Contracture Scar Volar Aspect, R Ring Finger 7805 0% 20021203
Low Back Pain Not Unfitting Lumbar Strain 5292 10% 20021206
HL, Tinnitus Not Unfitting Tinnitus (HL was NSC) 6260 10% 20021205
Wrist Pain, Right Not Unfitting R Wrist Strain 5215 10% 20021206
No Additional MEB/PEB Entries
 Other x 3 20021203
Combined: 0%
 Combined: 70%
Derived from VA Rating Decision (VA RD ) dated 200 30721 ( most proximate to date of separation [ DOS ] ). NSC = not service connected


ANALYSIS SUMMARY: The Board utilizes VA evidence proximal to separation in arriving at its recommendations; and, DoDI 6040.44 defines a 12-month interval for special consideration to post-separation evidence. The Board’s authority as defined in DoDI 6044.40; however, resides in evaluating the fairness of Disability Evaluation System fitness determinations and rating decisions for disability at the time of separation. Post-separation evidence therefore is probative only to the extent that it reasonably reflects the disability and fitness implications at the time of separation. The PEB combined the right and left knee conditions into one bundled unfitting condition coded 5099-5003 rated at 0%. Although VASRD §4.71a permits combined ratings of two or more joints under 5003, it allows separate ratings for separately compensable joints. The Board must follow suit (IAW DoDI 6040.44) if the PEB combined adjudication is not compliant with the latter stipulation, provided that each “unbundled” condition can be reasonably justified as separately unfitting in order to remain eligible for rating. If the members judge that separately ratable conditions are justified by performance based fitness criteria and indicated IAW VASRD §4.7 (higher of two evaluations), separate ratings are recommended; with the stipulation that the result may not be lower than the overall combined rating from the PEB. The Board’s initial charge in this case was therefore directed at determining if the PEB’s combined adjudication was justified in lieu of separate ratings. To that end, the evidence for the right and left knee conditions are presented, with attendant recommendations regarding separate unfitness, and separate rating if indicated.

Chronic Bilateral Knee Pain. The first record in evidence for the left knee was dated 9 February 1994 when he noted intermittent pain with long distance running and that he was initially seen while in basic training. He was seen periodically over the next few years and noted that the symptoms were related to his activity level. On 19 July 1995, he had normal X-rays of the left knee. A bone scan a week later was normal for both knees. He was seen in orthopedics a week later and thought to have retropatellar pain syndrome (RPPS), but a magnetic resonance imaging (MRI) was requested to exclude a medial meniscal tear. It is not clear if this was accomplished or not, but the diagnosis was continued as RPPS. He also became symptomatic in his right knee and both were issued temporary profiles. He then was reclassified from airborne operations to the 77F MOS after a medical MOS Reclassification Board (MMRB). The record then fell silent until 1998 when he was again seen for bilateral knee pain, left >> right. He continued to be seen periodically for knee pain, the left more than the right. Repeat X-rays of the left knee on 26 February 2002 were normal. An MRI of the left knee on 14 March 2002 was normal other than a small effusion. A bone scan a week later was significant for bilateral uptake in the knee caps (patellae), left > right, consistent with a stress reaction. He was offered a lateral release (a procedure to realign the patella and treat RPPS), but declined. An MEB was then recommended. Three weeks later on 20 April 2002, he was playing basketball and heard a snap in his right knee. He was thought to have a contusion. He apparently reconsidered surgery and underwent a left lateral release on 13 May 2002 followed by rehabilitation. On 6 December 2002, an X-ray of the right knee was normal and on 17 December 2002, a right lateral release was performed. A 31 January 2003 orthopedic summary noted that the left knee symptoms began in 1994 after a bad parachute fall and that he had a second bad fall in 1995. His right knee symptoms were noted to have begun in 1998 without antecedent trauma. The CI reported that both knees continued to “pop,” give out, and were painful with running, but that both had improved with surgery. On examination, the scars were well healed and effusion absent. The knees were stable and without crepitus. The range-of-motion (ROM) was noted as “from 0 to at least 105 degrees of flexion bilaterally.” He was thought to have continued symptoms of patella-femoral arthrosis (non-inflammatory joint disease.) At the VA Compensation and Pension (C&P) exam performed on 6 December 2002, 7 months prior to separation and 11 days prior to the right lateral release, the CI reported daily pain on the right and that the left occasionally gave way. On examination, the knees were stable and non-tender. There was no effusion or crepitation. Internal rotation produced some medial discomfort. Extension was 0 degrees and flexion 135 and 140 degrees, right and left, respectively. The gait was normal. The narrative summary (NARSUM) was dated 17 March 2003, 3 months prior to separation. The CI reported a bad parachute landing in January 1994 which led to reclassification in December 1995. He underwent a second MMRB in August 2002 after the surgery on the left knee and had surgery on the right while in the probationary period. He was not improving and MEB recommended. The examiner noted that the CI had full ROM at a 17 January 2003 orthopedic evaluation (not in evidence.) On examination, the scar was well healed on the left and not mentioned for the right (implying that it was well healed as well). There was no instability, effusion, meniscal signs, or crepitus. The ROM was normal on the left and written at 35 degrees flexion on the right; the latter is thought to be a typo and it should have been 135 degrees. Motion was slightly painful. Later in the NARSUM, the examiner noted that the CI had regained full ROM, quadriceps strength, ability to ride a bicycle and swim, but could not run or walk fast for any distance secondary to knee pain. The 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.

Knee ROM
(Degrees)		 VA C&P ~7 Mo. Pre-Sep Ortho ~5 Mo. Pre-Sep
Left Right Left Right
Flexion (140 Normal) 140 135 > 105 >105
Extension (0 Normal) 0 0
Comment Stable knee Stable knee Painful motion noted at MEB
§4.71a Rating 10% 10% 10% 10%
* T he MEB ROM numbers are from the VA exam of 20021206 . However, the examiner noted full ROM in the summary.

The Board first considered if the right and left knee were separately unfitting. Each was separately profiled at one point and each had surgery. While the left knee was more symptomatic, the evidence supports that each knee was separately and unfitting. The Board then direct s attenti on to its rating recommendation based on the above evidence . The examination most proximate to separation noted full ROM. It was not recorded as a goniometric measurement; however, this is consistent with other measurements, though. Regardless, the limitation in motion is not compensable in and of itself. However, this examination did note painful motion. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt) and §4.59 (painful motion) , the Board recommends a disability rating of 10 % for the each knee .
Contended PEB Conditions . The Board’s main charge is to assess the fairness of the PEB’s determination that the nasal septal deviation, ingrown toenail, right ring finger, LBP, tinnitus/HL, and right wrist pain conditions were not unfitting. The Board’s threshold for countering 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 “fai r and equitable” standard. These condition s were n ot profiled other than the hearing loss, which carried an H2 profile from accession to separation, and the LBP which had a temporary profile 17 months prior to separation and again on the final profile . None were implicated in the commander’s statement or judged to fail retention standards. An audiogram on 4 October 2002 was essentially unchanged for the 1997 baseline audiogram. The VA C&P examination documented back ROM better than VA normal values without tenderness or spasm. The gait was normal. An orthopedic examination on 3 February 2003 confirmed these findings. All contended conditions were reviewed by the a ction o fficer and considered by the Board. There was no performance based evidence from the record that any significantly interfered with satisfactory duty performance. After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the any of the contended conditions and so no additional disability ratings are recommended.


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 bilateral RPPS condition, the Board unanimously recommends a disability rating of 10% for each knee, coded 5099-5003 IAW VASRD §4.71a. In the matter of the contended nasal septal deviation, ingrown toenail, right ring finger, LBP, tinnitus/HL, and right wrist pain conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting. 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 his prior medical separation:

UNFITTING CONDITION VASRD CODE RATING
Chronic Right Knee Pain Secondary to Patello-femoral Arthrosis 5099-5003 10%
Chronic Left Knee Pain Secondary to Patello-femoral Arthrosis 5099-5003 10%
COMBINED (w/ BLF) 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20121005, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record








                                   
XXXXXXXXXXXXXXXXXX, DAF
President
Physical Disability Board of Review


 invalid font number 31502 SAMR-RB                                                                         

invalid font number 31502
MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557


 invalid font number 31502 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
invalid font number 31502 for XXXXXXXXXXXXXXXXXX invalid font number 31502 , AR20140013241 (PD201201789)

 invalid font number 31502
1. 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 to modify the individual’s disability rating to 20% without recharacterization of the individual’s separation. This decision is final.

2. I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.

3. I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:


 invalid font number 31502
invalid font number 31502
Encl                                                  XXXXXXXXXXXXXXXXXX invalid font number 31502
                                                      Deputy Assistant Secretary
                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

Similar Decisions

  • AF | PDBR | CY2014 | PD-2014-00701

    Original file (PD-2014-00701.rtf) Auto-classification: Approved

    Pre-Separation)ConditionCodeRatingConditionCodeRatingExam Chronic Bilateral Knee Pain due to RPS5009-50030%RPS Right Knee526010%20030403RPS Left Knee526010%20030403Other x0Other x920030403 Combined: 0%Combined: 60%Derived from VA Rating Decision (VARD)dated 20030725(most proximate to date of separation [DOS]) ANALYSIS SUMMARY :The PEB combined the right and left knee conditions under a single Service disability rating, coded analogously to 5003. After due deliberation in consideration of...

  • AF | PDBR | CY2012 | PD2012 01827

    Original file (PD2012 01827.rtf) Auto-classification: Approved

    The CI was then medically separated. IAW DoDI 6040.44, the Board must use the VASRD coding and rating standards which were in effect at the time of the CI’s separation from service. 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...

  • AF | PDBR | CY2013 | PD-2013-02688

    Original file (PD-2013-02688.rtf) Auto-classification: Approved

    The Informal PEB (IPEB)adjudicated the chronic bilateral knee pain as unfitting, rated 10%, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation. invalid font number 31502 BOARD FINDINGS : IAW DoDI 6040.44, provisions of DoD or Military...

  • AF | PDBR | CY2013 | PD2013 00053

    Original file (PD2013 00053.rtf) Auto-classification: Approved

    The VA coded each knee individually and used the analogous code 5999-5014 asosteomalachia and rated at each one at 10%.The service treatment record (STR) contained an equal amount of documentation relative to the left or right knee with the majority of documentation pertaining to the bilateral knee pain with activities. The left ankle physical exam findings of dorsiflexion limited to 10degrees (normal 20 degrees).The C&P examiner documented that the CI had daily pain with activities in all...

  • AF | PDBR | CY2013 | PD2013 01539

    Original file (PD2013 01539.rtf) Auto-classification: Approved

    The CI non-concurred and the Reconsideration PEB only adjudicated the “posttraumatic arthritis, right ankle…” as unfitting, rated 10%, identifying all other conditions as not unfitting. Right Ankle Condition . Physical Disability Board of Review

  • AF | PDBR | CY2012 | PD 2012 00953

    Original file (PD 2012 00953.rtf) Auto-classification: Approved

    The PEB adjudicated bilateral anterior knee pain syndrome as unfitting, rated 0% with likely application of the US Army Physical Disability Agency (USAPDA) pain policy and recurrent stress fracture of right tibia as unfitting, rated 0% with application of the VA Schedule for Rating Disabilities (VASRD). The MEB examiner referred to the exam results documented on the MEB DD Form 2808 which are summarized in the chart above.The VA Compensation and Pension (C&P) exam approximately 8 days prior...

  • AF | PDBR | CY2013 | PD-2013-01846

    Original file (PD-2013-01846.rtf) Auto-classification: Approved

    Post-Separation) ConditionCodeRatingConditionCodeRatingExam Bilateral Knee Pain5099-50030%Left Knee Degenerative Joint Disease5010-526010%20050430Right Knee Degenerative Joint Disease5010-526010%20050430Other x 4 (Not in Scope)Other x 320050503 Combined: 0%Combined: 30%Derived from VA Rating Decision (VARD)dated 20050608 ( most proximate to date of separation) ANALYSIS SUMMARY :The Board’s authority as defined in DoDI 6040.44, resides in evaluating the fairness of Disability Evaluation...

  • 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 | CY2014 | PD-2014-00894

    Original file (PD-2014-00894.rtf) Auto-classification: Approved

    The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation. There was no right knee instability noted at the MEB exam. In the matter of the bilateral knee pain condition, the Board unanimously recommends that each joint be separately adjudicated as follows: an unfitting right knee pain condition coded 5003 and rated 10%, and an...

  • AF | PDBR | CY2014 | PD-2014-01186

    Original file (PD-2014-01186.rtf) Auto-classification: Denied

    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 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. Bilateral Knee...