Search Decisions

Decision Text

AF | PDBR | CY2013 | PD-2013-01978
Original file (PD-2013-01978.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX        CASE: PD -20 1 3 - 0 1978
BRANCH OF SERVICE: NAVY   BOARD DATE: 201 5 0121
Separation Date: 20060106


SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve O-3 (Surface Warfare Officer) medically separated for bilateral anterior knee pain. The condition could not be adequately rehabilitated to meet the physical requirements of her rating or satisfy physical fitness standards. She was placed on limited duty (LIMDU) and referred for a Medical Evaluation Board (MEB). The bilateral knee condition, characterized as “pain in lower leg joint” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. No other conditions were submitted by the MEB. The Informal PEB adjudicated “bilateral anterior knee pain” as unfitting, rated 10%. The PEB also adjudicated p atella m echanism m alalignment and p robable c hondromalacia l eft k nee and r ight k nee p ain s tatus p ost o steochondral d efect d rilling and l ateral d isease as Category II conditions (“Conditions contributing to the unfitting condition”). The CI appealed to the Formal PEB, but later withdrew the appeal and was medically separated.


CI CONTENTION : “I am responding to this application for a review of my physical disability rating because I was not fairly rated when my physical board initially went up for review it was rushed thru and my case was not handled with care. For instance, I have problems with both of my knees with surgery on the right. I don’t think 10% rating on my knees was fair at all my left ear has problems after being on the carrier with the constant flux of airplanes. 10% was not fair rating for my hearing. These body parts mean more to me than 10%. That’s like 10% of a $1.00 which is .01. My knees and ears are needed to function, to work, to enjoy life so yes I feel that I was underrated and I would like a review of my board. Also, I recently submitted or reopened my case with my Bipolar Disorder. I submitted for PTSD so that is currently in process now. Also have existing Dental Problems that occurred while I was in the Navy and having problems now. When I was examined for Fibrocystic Breast Disease and the results came back stating that this existed prior to service which is not true and I don’t know where they gathered that evidence from. So I would like a new board review!”


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/Naval 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 20050808
 VA - (9 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Bilateral Anterior Knee Pain 5299-5003 10% Patellofemoral Syndrome Bilateral Knees 5099-5003 10% 20061005
Patella Mechanism Malalignment and Probable Chondromalacia Left Knee
 Category II
Right Knee Pain s/p Osteochondral Defect Drilling and Lateral Release
 Category II
Other x 0 (Note in Scope)
 Other x 2
Rating: 10%
 Combined: 40%
Derived from VA Rating Decision (VARD) dated 20061019 (most proximate to date of separation [DOS])


ANALYSIS SUMMARY :

Bilateral Anterior Knee Pain Condition . T he CI developed bilateral knee pain in 2002 after a physical fitness test in which she tripped and twisted her knee with swelling . She was started on a non-steroidal anti-inflammatory drug (NSAID) which provided temporary pain relief. The CI continued to have anterior left knee pain after exercising, stair climbing and squatting. The or thopedist noted that the CI reported that the left knee was more painful than the right knee at the time of the evaluation. The examiner noted that left knee X -rays showed mild degenerative changes in the patellofemoral joint. The left knee magnetic resonance imaging ( MRI ) was normal. The o rthopedist continued to note left knee pain, tenderness along the medial joint line and a range - of - motion (ROM) o f 120 degrees flexion (norm al is 140 degrees ). The examiner diagnosed left knee patellofemoral syndrome and opined that the CI would benefit from Hyalgen therapy. The CI was given her first Hyalgen injection for the right knee on 4 October 2004 . The right knee demonstrated limited flexion to 120 degrees and tenderness along the medial joint line . A second Hyalgen injection in the right knee was given on 11   October 2004. A right knee MRI demonstrated slight injury to the anterior cruciate ligament with minimal degenerative changes. The third Hyalgen injection was given on 15 November 2004. The CI underwent a right knee arthroscopy with drilling of osteochrondral defect of the lateral femoral condyle; lateral release and limited synovectomy on 26 January 2005 . Post - operatively, the CI was treated by p hysical t herapy (PT) from February 2005 through to June 2005. At follow-up, t he o rthopedist noted that she was doing well with her right knee and also noted the presence of anterior left knee pain . There were physical exam findings of right knee ROM flexion limited to 110 degrees, and left knee patellofemoral pain and some mal - tracking (patella slips out of the groove) . The examiner recommended a n NSAID, continued use of a splint, aggressive PT and Hyalgen injections for the left knee pain . The o rthopedist documented pain and popping in both knees w ith physical exam findings of crepitus and pain now worse in the left knee. The MEB NARSUM exam 11 months prior to separation and a month after right knee surgery focused solely on the right knee. The examiner recommended an 8- month LIMDU ashore within CONUS with available o rthopedics and PT . The MEB NARSUM physical exam findings are summarized in the chart below. The MEB NARSUM a ddendum approximately 6.5 months prior to separation documented complaints of continued right knee pain and popping along with left knee chronic pain. The MEB NARSUM Addendum physical exam findings are summarized in the chart below. The VA Compensation and Pension (C&P) exam approximately 9 months after separation documented that the CI required braces and orthotics for walking, had occasional right knee pain and had bilateral knee pain, stiffness; left knee warmth, s welling and tenderness and right knee weakness with moderate bilateral knee flares that occurred weekly with limited ROM which lasted three to seven days. Plain film X -rays revealed degenerative changes of the left knee and a small effusion with degenerative changes in the right knee.

T here were t wo ROM evaluations in evidence, with documentation of additional ratable criteria, which the Board weighed in arriving at its rating recommendation; as summarized in the chart below.

Knee ROM (Degrees)
 MEB 11 Mo s . Pre-Sep MEB Addendum 6. 5 Mo s . Pre-Sep VA C&P 9 Mo s . Post-Sep
Left Right Left Right Left Right
Flexion (140 Normal)
 - 90 - - 110 125
Extension (0 Normal)
 - 20 - - 0 0
Comment
 1 month post-surgery; using crutches; antalgic gait; moderate effusion Pos. pain & crepitus, No effusion; No instability Antalgic gait; Pos. edema, pain & crepitus No crepitus ; No Deluca No instability; No crepitus
§4.71a Rating
 0 % 10 % 10 % * 10 % * 10 % * 10 % *
*IAW VASRD §4.40 (Functional loss) or §4.59 (Painful motion)

The Board directed attenti on to its rating recommendation based on the above evidence .

The PEB coded the bilateral knee pain condition under the single analogous code of 5099-5022 (p eriostitis ) which is rated using VASRD code 5003 ( degenerative arthritis ), rated at 10%. Although VASRD §4.71a permits combined ratings of two or more joints under 5003, it also 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 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 evidence makes clear that the right knee was associated with more disability than the left one in this case. It remains, however, that both knees were implicated by the narrative summary (NARSUM) and, the PEB adjudication designated each knee condition as Category II (those conditions that are contributing to the unfitting condition). Board members agreed that each knee should be conceded as separately unfitting; and, that coding and rating features were logically identical.

The VA used the same coding for the p atellofemoral s yndrome b ilateral k nees condition and also rat ed a t 10% . The MEB addendum and the C&P exams met the 10% criteria rating for the right and left knee with application of VASRD §4.10 ( Functional impairment ) , §4.40 , and §4.59. There were no compensable ROM measurements or pathology that would allow for the appropriate application of any knee specific VASRD code. Considering all of the evidence and mindful of VASRD §4.3 (r easonable doubt ) , the Board recommends a disability rating of 10% coded 5 2 99-5003 IAW VASRD §4.71a for the r ight a nterior k nee p ain and 10% coded 529 9-5003 IAW VASRD §4.71a for the l eft a nterior k nee p ain.


 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 r ight a nterior k nee p ain condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5003 IAW VASRD §4.71a. In the matter of the l eft a nterior k nee p ain condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5003 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
Right Anterior Knee Pain 5299-5003 1 0%
Left Anterior Knee Pain 5299-5003 10%
COMBINED (w/ BLF)
 2 0%


The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20 131023 , w/atchs
Exhib it B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record








                          
XXXXXXXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review




MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND
DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

Ref:     (a) DoDI 6040.44
(b) PDBR ltr dtd 1 Jul 15 ICO XXXXXXXXXXXXXXXXXX
(c) PDBR ltr dtd 15 Jun 15 ICO XXXXXXXXXXXXXXXXXX
(d) PDBR ltr dtd 12 Jun 15 ICO XXXXXXXXXXXXXXXXXX

1. Pursuant to reference (a) I approve the recommendations of the Physical Disability Board of Review set forth in references (b) through (e).

2. The official records of the following individuals are to be corrected to reflect the stated disposition:

a.       XXXXXXXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effective date of discharge.

b. XXXXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 70 percent disability rating (increased from 10 percent) effective date of discharge.

c. XXXXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability severance pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.


3. Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are complete.



XXXXXXXXXXXXXXXXXXXX
Assistant General Counsel
(Manpower & Reserve Affairs)

Similar Decisions

  • 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 | CY2012 | PD2012 01856

    Original file (PD2012 01856.rtf) Auto-classification: Approved

    There is insufficient evidence to support a finding of not unfitting for either knee.Therefore, it is reasonably justified that the CI be found unfit for continued military service in her MOS due to her left and right anterior knee pain with patellar crepitus and patellar apprehension condition. However, there is no evidence of any further examination in the record. Providing a correction to the individual’s separation document showing that the individual was separated by reason of...

  • 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...

  • AF | PDBR | CY2013 | PD-2013-01224

    Original file (PD-2013-01224.rtf) Auto-classification: Approved

    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.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 knee pain condition, the Board unanimously recommends...

  • AF | PDBR | CY2013 | PD-2013-01745

    Original file (PD-2013-01745.rtf) Auto-classification: Denied

    The knee condition, characterized as “bilateral anterior knee pain” was forwarded to the Physical Evaluation Board IAW SECNAVINST 1850.4E. 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. The VA coded it 5258 (cartilage, semilunar, dislocated) and assigned a rating of 20% to each knee.At the May 2004 C&P exam, the...

  • AF | PDBR | CY2013 | PD-2013-02810

    Original file (PD-2013-02810.rtf) Auto-classification: Approved

    The PEB adjudicated the three knee conditions as one condition, “chronic bilateral knee pain”, rated at 10% citing the US Army Physical Disability Agency (USAPDA) pain policy. Chronic Bilateral Knee Pain Condition . In the matter of the chronic bilateral knee pain condition, the Board , by an majority vote, recommends that each knee is separately unfitting and should be rated as follows : chronic right knee pain condition coded as 50 99-5003, rated at 10% and the chronic left knee...

  • 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 | 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 | 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...