Search Decisions

Decision Text

AF | PDBR | CY2013 | PD-2013-01530
Original file (PD-2013-01530.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX         CASE: PD-2013-01530
BRANCH OF SERVICE: Army  BOARD DATE: 20150123
SEPARATION DATE: 20040114

invalid font number 31502
SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E- 4 ( Petroleum Supply Specialist ) medically separated for left knee pain. The condition could not be adequately rehabilitated to meet the requirements of her Military Occupational Specialty; however, her profile indicated she could perform an alternate PT test (walk instead of run), so she was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The knee condition, characterized as “left knee pain,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded four other conditions (bilateral foot pain, hip pain, hearing loss and back pain) for PEB adjudication. The Informal PEB adjudicated the left knee pain as unfitting, rated 0%, with likely application of the VA Schedule for Rating Disabilities (VASRD). The remaining conditions were determined to be not unfitting. The CI made no appeals and was medically separated.


CI CONTENTION: The CI elaborated no specific contention in her 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 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 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 :

Service IPEB – Dated 20031027
 VA - (6 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Left Knee Pain… 5003 0% Retropatellar Pain Syndrome with Arthritis, Left Knee 5257 10% 20040427
Other x 4 (Not in Scope)
 Other x 13 20040427
Rating: 0%
 Combined: 50%
Derived from VA Rating Decision (VA RD ) dated 200 40726 .


ANALYSIS SUMMARY:

Left Knee Condition. The narrative summary noteed the CI developed left knee pain without trauma in April 2001. She was diagnosed with bursitis and given a steroid injection with temporary improvement. The CI had persistent pain and was diagnosed with retropatellar pain syndrome. Left knee X-rays performed on 30 July 2002 showed mild degenerative changes. Conservative treatment did not resolve the knee pain and orthopedic evaluation on 12 August 2002 noted knee range-of-motion (ROM) of extension limited by 5 degrees and flexion of 130 degrees, there was tenderness of the inside of the knee, but no effusion and no evidence of instability or cartilage injury. Magnetic resonance imaging of the left knee noted some tiny cysts of the knee near the lateral meniscus without an associated tear and no other abnormality was noted. Despite additional physical therapy the CI continued to report knee pain. At the MEB examination on 16 June 2003, 5 months prior to separation, the CI reported left knee pain aggravated by activity. The MEB physical examination noted tenderness to palpation over the anterior knee, no evidence of semilunar cartilage injury, instability, or laxity. ROM was extension–flexion of 0 degrees to 135 degrees (normal 0 degrees to 140 degrees). Sensation and reflexes were normal. Special testing by the orthopedic specialist on 13 September 2002 noted tenderness of the inside of the patella, with no medial or lateral joint line tenderness, no instability, and a negative patellar grind test.

At the VA Compensation and Pension examination on 27 April 2004, performed 6 months after separation, the CI reported constant left knee pain which did not incapacitate her and she had not lost any time from work. The VA exam noted a normal gait. Examination of the left lower leg was normal and ROM was extension–flexion of 0 degrees to 110 degrees. There was a knee effusion, without instability or evidence of cartilage injury. No additional imaging was performed because the CI was pregnant at the time of the examination.

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the left knee condition 0%, coded 5003 (degenerative arthritis) and the VA rated it 10%, coded 5257 (knee impairment). The Board agreed that the evidence in record supports a 10% rating IAW §4.71a with multiple codes-5003, 5260 (limited leg flexion), or 5261 (limited leg extension) IAW §4.59 (Painful motion), but does not achieve a 20% rating for two more joints with evidence of degenerative arthritis, or based on limitation of ROM alone. The Board also considered if there was evidence of instability to provide for dual rating based on separate ratings for instability and limitation of motion. However, there was no evidence in record of knee instability, laxity or intermittent patellar dislocation. The Board agreed there was no path to a higher evaluation than 10% and that utilizing analogous coding for patellofemoral/retropatellar pain syndrome of 5299-5261 (analogous to limited leg extension) was the most medically appropriate code for the knee condition. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the left knee 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 left knee condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5261 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:

UNFITTING CONDITION
 VASRD CODE RATING
Left Knee Condition 5299-5261 10%
COMBINED
 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20130918, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record







                 
XXXXXXXXXXXXXXXXXX
President
DoD 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 XXXXXXXXXXXXXXXXXX , AR20150008349 (PD201301530)
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 10% 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:




Enc l                                                  XXXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)

CF:
( ) DoD PDBR
( ) DVA

Similar Decisions

  • AF | PDBR | CY2012 | PD-2012-01087

    Original file (PD-2012-01087.pdf) Auto-classification: Denied

    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. ** R knee 10% effective from 20031021 Service PEB – Dated 20021219 Condition Code Left Knee Pain 5003 ↓No Additional MEB/PEB Entries↓ Rating 0% Exam 20%* 20040320 Code 5010 Rating VA (12 Mos. RECOMMENDATION: The Board recommends that the CI’s prior determination be modified...

  • AF | PDBR | CY2013 | PD-2013-01531

    Original file (PD-2013-01531.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. Post-Separation) ConditionCodeRatingConditionCodeRatingExam DJD Bilateral Knees500320%Left Knee Condition5257NSC*20040610Right Knee Condition5257NSC*20040610Other x 0 (Not In Scope) Combined: NSC*Combined: 20%Derived...

  • AF | PDBR | CY2014 | PD-2014-00024

    Original file (PD-2014-00024.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 theVeterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. Left Knee Condition . The Board agreed the left knee condition had someforward laxity but no lateral instability/subluxation after surgery, given the normal gaits, and findings on examinations proximate to...

  • AF | PDBR | CY2013 | PD2013 00543

    Original file (PD2013 00543.rtf) Auto-classification: Denied

    There was no documentation of a new injury. At the MEB narrative summary (NARSUM) exam, approximately 2months before separation, the CI reported being prescribed narcotic medication for the pain (which he was not using at that time) and continued intermittent locking and buckling about two to three episodes per day(there was no independent STR evidence to support knee locking/buckling). BOARD FINDINGS : IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines...

  • AF | PDBR | CY2013 | PD2013 00092

    Original file (PD2013 00092.rtf) Auto-classification: Denied

    The left knee condition, characterized as left knee severe degenerative joint disease (DJD), left knee anterior cruciate ligament insufficiency, left knee lateral meniscus tear and medial meniscus tear, was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. He had further knee re-injuries after the first two surgeries. The operative report described severe chondromalacial changes in the lateral compartment with osteophytic ridging in the patellofemoral joint, medial,...

  • AF | PDBR | CY2012 | PD2012 01825

    Original file (PD2012 01825.rtf) Auto-classification: Approved

    Post-SepFlexion (45⁰ Normal)45⁰‘Within functional limits’30⁰30⁰Combined (340⁰)340⁰215⁰215⁰§4.71a Rating10%*10%20%20%* Conceding §4.59 (painful motion).The Board directs attention to its rating recommendation based on the above evidence. A provider entry during that period noted left knee pain with various motions, but “right knee only ‘sore’ if stands up for prolonged periods.” Nearly all outpatient entries in the STR documented left knee dominance of symptomatology, with several mentioning...

  • AF | PDBR | CY2012 | PD 2012 00682

    Original file (PD 2012 00682.txt) Auto-classification: Denied

    An outpatient note (15 February 2001) reported a normal X- ray of the left knee. 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 Left Retropatellar Pain Syndrome 5299-5003 10% COMBINED 10% The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20120608, w/atchs Exhibit B. Service Treatment Record Exhibit C. Department of...

  • AF | PDBR | CY2012 | PD2012 01028

    Original file (PD2012 01028.rtf) Auto-classification: Denied

    Post-Separation) ConditionCodeRatingConditionCodeRatingExam Low Back Pain Secondary To Idiopathic Scoliosis (EPTS), Permanently Service Aggravated529510%Idiopathic Scoliosis With Upper And Lower Back Strain NSC20030204Bilateral Knee Pain Due To PatelloFemoral Pain Syndrome5099-50030%Right Knee Patellofemoral Pain SyndromeNSC20030204Left Knee Patellofemoral Pain SyndromeNSC20030204No Additional Unfitting conditionsOther x 120030204 Combined: 10% Combined: 0% Derived from VA Rating Decision...

  • AF | PDBR | CY2011 | PD2011-00819

    Original file (PD2011-00819.docx) Auto-classification: Denied

    ConditionCodeRatingConditionCodeRatingExam Pain Upper and Lower Back as Well as Both Knees with Negative Imaging Studies5099 50030%Mechanical Low Back Pain52950%20020610Retropatellar Pain Syndrome, Right Knee5099-50190%20020610Retropatellar Pain Syndrome, Left Knee5099-50190%20020610↓No Additional MEB/PEB Entries↓Cervical Spine condition52900%20020610Postoperative Cataract, Pseudophakla, Right Eye6028-602930%200206100% x 4/Not Service-Connected x 020020610 Combined: 0%Combined: 30% The...

  • AF | PDBR | CY2013 | PD-2013-01299

    Original file (PD-2013-01299.rtf) Auto-classification: Denied

    Post-Separation)ConditionCodeRatingConditionCodeRatingExam Chronic Bilateral Knee Pain due to Chondromalacia5099-500320%Chondromalacia Patella L Knee526120%20050311Chondromalacia Patella, R Knee526120%20050311Other X 0 (Not in Scope)Other x020050314 Combined: 20%Combined: 40%Derived from VA Rating Decision (VARD) dated 20050412 (most proximate to date of separation [DOS]) ANALYSIS SUMMARY :IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability...