Search Decisions

Decision Text

AF | PDBR | CY2013 | PD-2013-02194
Original file (PD-2013-02194.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2013-02194
BRANCH OF SERVICE: Army  BOARD DATE: 20150212
SEPARATION DATE: 20040720


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Motor Transport Operator) medically separated for right knee. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The “right knee post traumatic osteoarthritis” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other condition was submitted by the MEB. The Informal PEB adjudicated “posttraumatic arthritis right knee following ACL reconstruction” as unfitting, rated 10% with likely application of US Army Physical Disability Agency (USAPDA) pain policy. The CI made no appeals and was medically separated.


CI CONTENTION: “I feel my record should be reviewed because I feel the MEB was incorrect in my rating. I only received a 10% rating overall (with 2 other conditions being rated at 0%). At the time of my medical review and while undergoing MEB proceedings, I was consistently told by my superiors in my rear detachment unit, that it would be futile to file an appeal and that if undeployable overseas, I was of no use to the military. I do not feel that I had any representation during my MEB process and was pressured by my unit to give in and sign for the low initial rating I was granted by the board. I feel there were many issues that were minimized or not included in my review and decision by the MEB. In addition, the treatments for my conditions that worsened during my service times, specifically my knee, back, and headache issues, were delayed. Regardless of my pain level and inability to properly preform my job duties and I was only given medications or physical therapy with very little difference or success achieved. I feel the MEB board did not review my file correctly, minimizing the pain, severity, and functioning of my rated conditions. My right knee has never been right since my injury during service. I still walk in pain daily, can not bend my knee completely and have degenerative joint disease as a result of the injury and repair. I have lots of internal scar tissue and it flares up regularly to the point of extreme pain at times. My migraines began early in my Army career and progressively became worse during the course of my service and after my separation. During my visits to sick call, while on active duty, I was told to merely take ibuprofen and rest. Regardless of the severity and frequency of my migraines, I was discouraged from seeking any additional treatment beyond just ibuprofen and rest. Once separated from Army service, the doctors at the VA finally realized that I needed additional powerful medicines to finally control my migraines that had plagued me for my entire Army career.”

His complete submission is at Exhibit A.


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 :

IPEB – Dated 20040308
 VA* (~1 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Posttraumatic Arthritis Right Knee Following ACL Reconstruction 5010 10% Post Traumatic Arthritis Right Knee Status Post ACL Reconstruction 5003-5010 10% 20040817
Other x 0 (Not In Scope)
 Other x 2
RATING: 10%
 RATING: 10%
* Derived from VA Rating Decision (VA RD ) dated 200 40 92 0 (most proximate to date of separation ( DOS ) ) .


ANALYSIS SUMMARY:

Posttraumatic Arthritis Right Knee following ACL Reconstruction. The CI underwent surgery in April 2003 for reconstruction of right knee anterior cruciate ligament (ACL) and debridement of a medial meniscus tear. Orthopedic clinic examinations following surgery (25 June, 28 July 2003 and 25 September 2003) noted 1A Lachman (slight movement with firm endpoint indicating intact ACL) and negative anterior drawer (intact ACL), negative pivot shift (intact ACL for rotational stability), and negative McMurray (for meniscus). At the time of the MEB narrative summary (NARSUM) examination on 23 February 2004, there was 10 degrees of limited extension, flexion to 115 degrees, and the Lachman was graded as IIA indicating moderate laxity with a firm end-point (intact but lax ligament). Follow-up orthopedic examination on 4 May 2004 recorded improved extension with 5 degrees of limitation. At the VA Compensation and Pension (C&P) examination on 17 August 2004, a month after separation, the gait was normal and there was no swelling or effusion of the knee. Range-of-motion examination demonstrated full extension to 0 degrees and flexion to 110 degrees. Movement was accompanied by report of pain. There was no instability (negative Lachman) and the McMurray test for meniscus problems was negative.

The Board directed its attention to its rating recommendation based on the above evidence. The PEB rated the posttraumatic arthritis of the right knee following ACL reconstruction 10% (coded 5010, arthritis due to trauma). The VA rated the right knee (post ACL reconstruction with medial meniscus debridement and degenerative joint disease) 10% (coded 5010-5260) citing painful motion and absence of instability. Although the MEB NARSUM examination reported 10 degrees loss of extension supporting a 10% rating for limitation of extension (diagnostic code 5261) subsequent orthopedic and VA C&P examinations did not demonstrate limited extension. Evidence of the record supports a 10% rating for painful motion, functional loss, or symptomatic status post removal of meniscus (5259). The MEB NARSUM examination reported some laxity of the ACL however examinations prior to and subsequent to this examination did not document significant instability or subluxation that would support a rating under the diagnostic code for recurrent subluxation or lateral instability (5257). 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 adjudication determination for the right 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. In the matter of the post traumatic arthritis of the right knee following ACL reconstruction 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 re-characterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131104, w/atchs
Exhibit 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, AR20150010414 (PD201302194)


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

Similar Decisions

  • AF | PDBR | CY2012 | PD-2012-01355

    Original file (PD-2012-01355.txt) Auto-classification: Approved

    Right Knee Pain Condition. The Board noted the PEB rated the knee condition using the code for knee instability (5257). The Board noted the MRI findings showing evidence of a deficient ACL and MEB NARSUM examination with a positive Lachman test graded 1+.

  • AF | PDBR | CY2011 | PD2011-00389

    Original file (PD2011-00389.docx) Auto-classification: Denied

    The Board evaluates DVA evidence proximal to separation in arriving at its recommendations, but its authority resides in evaluating the fairness of DES fitness decisions and rating determinations for disability at the time of separation. The multiply-operated left knee with anteromedial knee pain, subjective instability and mechanical symptoms condition, analogously coded 5299-5003, per VASRD direction, would warrant a 10% rating as given by the PEB and the VA. With non-compensable ROM...

  • AF | PDBR | CY2012 | PD2012 00229

    Original file (PD2012 00229.rtf) Auto-classification: Denied

    The single voter for dissent (who recommended a separate left knee 20% and right knee 10% rating)submitted the appended minority opinion.In the matter of the contended asthma, LBP and OSA conditions, the Board unanimously recommends no change from the determinations as not unfitting.There were no other conditions within the Board’s scope of review for consideration. The AO therefore recommends that each joint be separately rated as follows: an unfitting left knee condition coded 5010-5258...

  • AF | PDBR | CY2014 | PD-2014-01692

    Original file (PD-2014-01692.rtf) Auto-classification: Denied

    No other conditions were submitted by the MEB.The Informal PEB adjudicated “traumatic osteoarthritis left knee, with OCD lesions, lateral femoral condyle and tibial plateau, s/p ACL reconstruction and microfracture of left femoral condyle”as a single unfitting condition, rated 10%,with likely application of theVA Schedule for Rating Disabilities (VASRD).The CI made no appealsand was medically separated. RECOMMENDATION : The Board, therefore, recommends there be no re-characterization of the...

  • AF | PDBR | CY2009 | PD2009-00094

    Original file (PD2009-00094.docx) Auto-classification: Denied

    If used, it would most likely be at the "Moderate" knee disability 20% level considering the totality of CI's knee exam and post-separation VA exam which demonstrated no worsening of CI's knee condition. In the matter of the Right Knee condition, the Board unanimously recommends separately coding the instability and painful motion of the CI's right knee with a rating of Chronic right knee instability s/p trauma, 5010-5257 at 20% and Right knee pain limited motion s/p trauma, 5010-5260 at...

  • AF | PDBR | CY2013 | PD2013 00064

    Original file (PD2013 00064.rtf) Auto-classification: Denied

    The PEB adjudicated “anterior knee pain after left anterior cruciate ligament (ACL) reconstruction” as unfitting, rated 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). There was no instability and examination of ligaments of the left knee was symmetrical compared to the uninjured left knee. Both the PEB and the VA rated the condition as 10% for painful motion of a major joint with similar coding (5010-5003 and 5257-5010 respectively).

  • AF | PDBR | CY2011 | PD2011-00737

    Original file (PD2011-00737.docx) Auto-classification: Approved

    SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (67U20/CH-47 Helicopter Repairman) medically separated for a right knee condition. Right Knee Condition . In the matter of the right knee condition, the Board unanimously recommends a dual coding disability rating for a combined rating of 30%, IAW VASRD §4.71a.

  • AF | PDBR | CY2011 | PD2011-00033

    Original file (PD2011-00033.docx) Auto-classification: Denied

    The Informal PEB adjudicated the right knee ACL instability existed prior to service (EPTS) and right knee medial meniscus tear and lateral meniscus tear conditions as unfitting, combined under a single code and rated 20% with likely application of the US Army Physical Disability Agency (USAPDA) pain policy, Department of Defense Instruction (DoDI) 1332.39 and Veteran’s Administration Schedule of Rating Disabilities (VASRD). ConditionCodeRatingConditionCodeRatingExam Right Knee ACL...

  • AF | PDBR | CY2012 | PD2012-00622

    Original file (PD2012-00622.pdf) Auto-classification: Denied

    Pre-Sep 135⁰ 0⁰ 140⁰ 0⁰ ROM additionally limited by pain; slight anterior subluxation with some instability 10% 10%* Left Knee ROM Flexion (140⁰ Normal) Extension (0⁰ Normal) Comment §4.71a Rating 5099-5003 or 5010 5257 +painful motion and tenderness; 1A Lachman, +anterior drawer 10% 10%* *If instability conceded At the narrative summary (NARSUM) examination performed 3 months prior to separation (2 August 2002), the CI reported sharp anterior knee pain when twisting, and occasional swelling...

  • AF | PDBR | CY2011 | PD2011-01029

    Original file (PD2011-01029.docx) Auto-classification: Denied

    Although the PEB adjudicated “bilateral knee” as the unfitting condition, the record of proceedings reflects separate codes and ratings for each knee, with application of the bilateral factor in computing the combined rating, which is consistent with VASRD standards. No other conditions were service-connected with a compensable rating by the VA within 12 months of separation or contended by the CI. Exhibit C. Department of Veterans Affairs Treatment Record