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AF | PDBR | CY2013 | PD 2013 00518
Original file (PD 2013 00518.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX     CASE: PD -20 13 - 00 518
BRANCH OF SERVICE: Army   BOARD DATE: 2014 0924
Separation Date: 20020430


SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (98G3L/Linguist) medically separated for degenerative joint disease (DJD) right knee, status post right knee high tibial osteotomy. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS). He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The degenerative joint disease (DJD) right knee, status post (s/p) right knee high tibial osteotomy condition, characterized as right knee degenerative joint disease, s/p right knee high tibial osteotomy was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The Informal PEB adjudicated “degenerative joint disease (DJD) right knee, status post right knee high tibial osteotomy” as unfitting, rated at 10%. The CI made no appeals and was medically separated.


CI CONTENTION : “PEB decision was based on Degenerative Joint Disease in right knee following surgery to mitigate symptoms. PEB exam included range of motion test conducted lying down (no load on knee). Other documented issues were not considered, including heel spur, collapsed arch and associated chronic tendonitis in left foot/ankle and intermittent atypical vertigo. Not able to run, walk long distances, or stand> 15 min without severe pain.”


 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 DJD right knee condition is addressed below. The contended heel spur, collapsed arch, chronic tendonitis and vertigo conditions were not identified by the MEB or PEB, thus are not within the DoDI 6040.44 defined purview of the Board. These and any other condition 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 20020225
 VA* - (1 Mos. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
DJD, Right Knee 5003 10% Right Knee s/p Osteotomy Proximal Tibial Plateau, with DJD 5010-5262 20% 20020329
Other x 0 (Not in Scope)
 Other x 5 (Not in Scope)
Combined: 10%
 Combined: 50%
* Derived from VA Rating Decision (VARD) dated 20021007 (most proximate to date of separation )
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ANALYSIS SUMMARY : The Board acknowledges the CI’s assertions that his disability disposition “included range-of-motion test conducted lying down (no load on knee).” It is noted for the record that the Board has no jurisdiction to investigate or render opinions in reference to such allegations. These issues may be addressed by the Board for the Correction of Military Records and/or the United States judiciary system. Additionally, the Board acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation. That role and authority is granted by Congress to the Department of Veterans' Affairs, operating under a different set of laws. The Board considers VA evidence within 12 months only to the extent that it reasonably reflects the disability at the time of separation.

DJD Right Knee Condition . The CI had a long history of chronic right knee pain and arthritis dating from 1992. He underwent an arthroscopy for right knee osteophyte debridement on
5 April 1992. A computed tomography scan showed right knee arthr itis with mild to moderate DJD. The CI underwent a second right knee arthroscopy on 25 August 1997 , to remove a bone spur . Throughout 1998 to 2000, the CI was seen intermittently for flares of right knee pain exacerbated by walking and activity . A right knee X -ray image showed a high tibial osteotomy and degenerative arthritis at the right knee joint. The o rthopedist documented crepitus with range-of-motion ( ROM ) , mild effusion and a mild varus deformity. He continued to have a severe antalgic gait, crepitus, edema and patellar tendon tenderness. The CI underwent a n arthroscopic procedure to correct to alignment of his tibia. He was evaluated by physical therapy for recurring right knee pain with walking and activity. The o rthopedist noted pain depending on activity with physical exam findings of edema, effusion and poor quad tone. The o rthopedist noted pain with prolonged walking, going up / down stairs , morning stiffness and pain with prolonged sitting. The pertinent physical exam findings were decreased light touch; 2+ varus instability and 1+ Lachman's. The CI was given a permanent L3 p rofile for right knee arthritis and the c ommander’s s tatement indicated that due to the CI’s medical condition he was not able to perform his MOS.

The MEB narrative summary (NARSUM) exam (performed a pproximately 5 months prior to separation ), documented the CI continued to have right knee pain and limitations with activity. The examiner rated the pain in accordance with the American Medical Association (AMA) as constant and slight and that the CI continued to have severe limitations performing strenuous activities and walking. The MEB NARSUM physical exam findings are summarized in the chart below .

 The VA Compensation and Pension (C&P) exam approximately a month prior to separation documented right knee arthritis. The VA C&P physical exam findings are summarized in the chart below .

The ROM evaluation s in evidence with which the Board weighed in arriving at its rating recommendation; are sum marized in the chart below:

Right Knee ROM (Degrees)
MEB 5 Mos. Pre-Sep VA C&P 1 Mo. Pre-Sep
Flexion (140 Normal)
 130 No ROM recorded
Extension (0 Normal)
 0
Comment
 Pos. antalgic gait & tenderness to palpation over hardware; Pos. crepitus & effusion; Pos. medial joint line tenderness; Stable ligaments Pos. antalgic gait; Decreased strength
§4.71a Rating
 10% 10% (VA 20%)
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The Board directs attenti on to its rating recommendation based on the above evidence . The PEB coded the DDD r ight k nee condition as 5003 a rthritis, degenerative (hypertrophic or osteoarthritis) and rated at 10%. The VA coded the r ight k nee s / p o steotomy p roximal t ibial p lateau, with DJD condition and rated at 5010 a rthritis, due to trauma, substantiated by X -ray findings with 526 2 t ibia and f ibula, impairment of and rated at 20% , w ith moderate knee disability , citing, “ This 20 percent is considered to be made up of 10 percent for painful motion with arthritis, shown at exam, plus 10 percent for slight instability noted by laxity of anterior drawer testing.”

The Board members considered VASRD cod e 5262, impairment of the tibia and fibula; however , based on the evidence, the Board agreed that the knee condition did not rise to the m oderate level as required for a 20% rating. All exams performed proximate to separation documented painful motion. The Board reviewed the file for evidence of right knee instability and Board members agree that there was no evidence instability. No exam indicated current symptoms related to meniscal injury, or limited ROM to a compensable level without application of §4.59 Painful motion. VASRD §4.71a specifies for 5003 that satisfactory evidence of painful motion limitation of motion and specifies a 10% rating for each major joint or group of minor joints affected by limitation of motion. The Board considered all other potential evidence based coding schemes; however , no other coding schema would result in a higher 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 D J D r ight k nee condition.

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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 right knee degenerative joint disease 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.

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invalid font number 31502 RECOMMENDATION invalid font number 31502 : invalid font number 31502 The Board, therefore, recommends that there be no re-characterization of the CI's disability and separation determination. invalid font number 31502


The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20 130304 , w/atchs
Exhib it B. Service Treatment Record
Exhibit C. Department of Veterans ’ Affairs Treatment Record










                          
XXXXXXXXXXXXXXX
President
Physical Disability Board of Review



SAMR-RB                                                                         


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


SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXX, AR20150003726 (PD201300518)


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                                                  XXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)
                                                     
CF:
( ) DoD PDBR
( ) DVA

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