Search Decisions

Decision Text

AF | PDBR | CY2012 | PD2012 01952
Original file (PD2012 01952.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    CASE: PD1201952
BRANCH OF SERVICE: Army  BOARD DATE: 20130611
SEPARATION DATE: 20030508


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSG/E-6 (55D/Explosive Ordinance Disposal Specialist) medically separated for chronic bilateral knee pain. The CI reports that he began having right knee pain in approximately 1997. He denies any trauma to his right knee. He does report that he had a left medial meniscal tear in 1992 and underwent arthroscopy with partial meniscectomy at that time. He reports that he did well after the surgery and continued to play football for two more years pain-free. He reports that his left knee pain began in approximately 1998. The condition could not be adequately rehabilitated 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). The chronic bilateral knee pain condition(s) characterized as medically unfit and was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The PEB adjudicated chronic bilateral knee pain as unfitting, rated 10% citing criteria of the US Army Physical Disability Agency (USAPDA) pain policy. The CI made no appeals and was medically separated.


CI CONTENTION: The CI elaborated no specific contention in his application.


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 chronic bilateral knee pain conditions is addressed below; and, no additional 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 20030228
 VA - (5 Mos. Pre -Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Bilateral Knee Pain 5099-5003 10% Retopatellar Pain Synd. L Knee 5260 10% 20021216
Retopatellar Pain Synd. R Knee 5260 10% 20021216
No Additional MEB/PEB Entries
 Other x 4 20021216
Combined: 10%
 Combined: 20%
Derived from VA Rating Decision (VA RD ) dated 200 30512 (most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY:

Chronic Bilateral Knee Pain Condition. Prior to entering service the CI had a left medial meniscal tear in 1992 and had arthroscopy with partial meniscectomy. He became pain free and entered service in October 1995. By 1998 he had constant dull aching pain in both knees and he was diagnosed with retropatellar syndrome. There was no history of trauma but CI related the pain to constant training and combat maneuvers and marching. X-rays of the knees on 2 June 2000 were negative. The pain in his knees worsened; although he was treated with physical therapy and medications. He had not been able to perform fitness testing since December 2001. X-rays performed in November 2002 of both knees were normal. Orthopedics recommended permanent profile for bilateral retropatellar pain syndrome. Duty limitations included no carrying the rucksack, and no prolonged marching in Kevlar and body armor. At the VA Compensation and Pension (C&P) exam performed prior to the MEB examinations and 5 months prior to separation, the CI reported he had no functional impairments and no loss of work time. Exam of knees revealed a range-of-motion (ROM) of flexion 140 degrees and extension 0 degrees. There was no limitation by pain, weakness, fatigue, lack of endurance or incoordination. There was no evidence of ankylosis, laxity, subluxation, locking pain, effusion, or crepitus bilaterally. No pathology was noted and there was no limitation or restrictions on daily activities or his occupation. The condition did not require bed rest or the attention of a physician. The MEB physical examination documented on DD Form 2808, dated 26 December 2002, noted tenderness of the patella bilateral, medial greater than lateral, with negative effusion. The MEB narrative summary physical exam on 2 January 2003, noted tenderness to palpation of the patella of both knees. ROM was full without discomfort. Tests for laxity and instability were negative. Gait was normal.

The Board directs attention to its rating recommendation based on the above evidence. The VA rated the condition 10% for right patellofemoral pain and 10% for left patellofemoral pain. The PEB combined the right and left conditions as a single unfitting condition coded analogously to 5003 and rated 10% with application of the USAPDA pain policy AR 635-40 B24.f. The approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications or implied adjudication that each condition was separately unfitting. The Board also noted that “bundling,” the combining of two or more major joints is permissible under the Veterans Affairs Schedule for Rating Disabilities (VASRD) 5003 rating requirements, and that this approach does not compromise the VASRD §4.7 directive to choose the higher of two valid ratings. The Board’s initial charge in this case was therefore directed at determining if the PEB’s approach of combining conditions under a single rating was justified in lieu of separate ratings. When considering a separate rating for each condition, the Board considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability. Review of treatment records indicates that the CI was treated for bilateral knee pain. All records refer only to bilateral knees, including the physical profile and the commander’s statement. Neither knee was described to be more severe than the other. The Board noted the normal X-rays and examinations with minimal findings and concluded that each knee when considered separately was not reasonably justified as unfitting. However, for the same there was not a preponderance of evidence to support a finding that either knee could be stated to be not unfit. Therefore the Board considered the rating for the bilateral knee condition. There was no limitation of motion to attain a minimum rating under the VASRD diagnostic codes for limitation of motion (5260 and 5261), and there was no instability or meniscus problems to warrant rating under the respective codes (5257, 5258, 52959). The Board noted the normal painless ROM, normal X-rays and absence of functional impairment except in strenuous military duties in his EOD MOS more nearly approximating a 0% rating. 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 chronic 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. As discussed above, PEB reliance on the USAPDA pain policy DoDI 1332.39 for rating chronic knee pain was operant in this case and the condition was adjudicated independently of that policy/instruction by the Board. In the matter of the chronic bilateral knee pain 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
Chronic Bilateral Knee Pain 5099-5003 10%
COMBINED
 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20121101, 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 AR20130018485 (PD201201952)

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

Similar Decisions

  • AF | PDBR | CY2012 | PD 2012 01752

    Original file (PD 2012 01752.txt) Auto-classification: Approved

    After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), §4.59 (painful motion), and §4.40 (functional loss), the Board recommends that the bilateral knee condition be rated for two separate unfitting conditions as follows: right knee pain coded 5299-5260 rated 10% and left knee pain coded 5299-5260 rated 10%. In the matter of the bilateral knee pain condition, the Board unanimously recommends that each joint be separately adjudicated as follows:...

  • AF | PDBR | CY2013 | PD-2013-02101

    Original file (PD-2013-02101.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. 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...

  • AF | PDBR | CY2013 | PD-2013-01822

    Original file (PD-2013-01822.rtf) Auto-classification: Approved

    Bilateral knee degenerative joint disease (DJD), left greater than right and left ankle pain were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. Post-Separation) ConditionCodeRatingConditionCodeRatingExam Degenerative Arthritis of the Knees500310%Degenerative Joint Disease, R Knee5010-526010%20040925Degenerative Joint Disease, L Knee5010-526010%20040925Left Ankle PainNot UnfittingLeft Ankle Sprain5299-52700%20040925Other x 0 (Not in Scope)Other x 6 Rating: 10%Combined:...

  • AF | PDBR | CY2012 | PD2012 01855

    Original file (PD2012 01855.rtf) Auto-classification: Denied

    No other conditions were submitted by the MEB.The PEB adjudicated “chronic bilateral knee pain, rated as slight/constant”as unfitting and rated 10% in accordance with theUS Army Physical Disability Agency (USAPDA) pain policy.The CI made no appeals and was medically separateda10% disability 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...

  • AF | PDBR | CY2012 | PD 2012 00969

    Original file (PD 2012 00969.txt) Auto-classification: Denied

    The PEB adjudicated the chronic bilateral knee pain due to RPS condition as unfitting, rated 0%, with application of the US Army Physical Disability Agency (USAPDA) pain policy. (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. ...

  • 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...

  • AF | PDBR | CY2012 | PD-2012-01476

    Original file (PD-2012-01476.txt) Auto-classification: Denied

    The PEB adjudicated the chronic right anterior knee pain, rated as slight condition as unfitting, rated 10% with application of the US Army Physical Disability Agency (USAPDA) pain policy. The CI was seen by orthopedics for the constant right knee pain with running in September 1993. 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 Chronic Right...

  • AF | PDBR | CY2012 | PD2012 01266

    Original file (PD2012 01266.rtf) Auto-classification: Denied

    Bilateral Knee Condition . Members agreed that the functional limitations as described in the NARSUM, the VA exam and as described in the NMA justified the conclusion that the right knee and left knee conditions were each integral to the CI’s inability to perform activities required of his MOS; and, accordingly a separate rating for each knee is recommended.The Board noted that the C&P exam which was proximal to the CI’s date of separation, demonstrated slight pain-limited motion andthe...

  • AF | PDBR | CY2012 | PD2012 01689

    Original file (PD2012 01689.rtf) Auto-classification: Approved

    The back and bilateral knee conditions, characterized as “chronic non-radicular low back pain”and“chronic bilateral knee pain”were forwarded as not meeting retention standards, to the Physical Evaluation Board (PEB) IAW AR 40-501.A symptomatic pes planus condition was identified by the MEB and also forwarded as failing retention standards.The informal PEB adjudicated the chronic low back and bilateral knee pain conditions as unfitting, rated 10% and 0%.The remaining condition was determined...

  • 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...