Search Decisions

Decision Text

AF | PDBR | CY2013 | PD-2013-02387
Original file (PD-2013-02387.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX  CASE: PD-2013-02387
BRANCH OF SERVICE: Army  BOARD DATE: 20140812
SEPARATION DATE: 20051223


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (11B/Infantry) medically separated for a bilateral knee condition. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The knee condition, characterized as “bilateral retropatellar pain syndrome, left greater than right” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded one other condition (hyperlipidemia) for PEB adjudication. The Informal PEB adjudicated “chronic bilateral knee pain” as unfitting, and rated it 0%. The other condition was found to be not unfitting . The CI made no appeals and was medically separated.


CI CONTENTION: The CI attached a statement (contending left foot fracture, both knees and high blood pressure) to his application, which was reviewed by the Board and considered in its recommendations. 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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI. The rating for the unfitting bilateral knee condition is addressed below. No other 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 20051208
 VA – (6 mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Bilateral Knee Pain 5099-5003 0% Right Knee Strain 5257 10% 20060603
Left Knee Strain 5257 10% 20060603
Other x 1 (Not in Scope)
 Other x 6 20060603
Combined: 0%
 Combined: 20%
Derived from VA Rating Decision (VA RD ) dated 200 60718 ( most proximate to date of separation [ DOS ] )


ANALYSIS SUMMARY:

Knee pain. In November 2001, after a 2-mile run, this CI developed bilateral knee pain. He was diagnosed with retro-patellar pain syndrome and was treated with physical therapy and medications. In spite of treatment, his knee pain persisted and an MEB was initiated. The MEB physical examination (PE) was in November 2005. At that time, there was no varus/valgus laxity and drawer sign was negative bilaterally. Both knees had full range-of-motion (ROM) to flexion and extension. There was mild tenderness to palpation around the patellar region of both knees. Muscle strength and deep tendon reflexes were normal. The examiner’s diagnosis was: “Bilateral retro-patellar pain syndrome, left greater than right.” As noted above, the CI was found unfit for duty and was separated from military service on 22 December 2005. Five months later, he had a VA Compensation and Pension exam. PE of his knees revealed no deformity. There was full ROM from 0 degrees to 140 degrees.

The Board carefully reviewed all evidentiary information available and directs attention to its rating recommendation. The Army PEB combined the CI’s knee pain into a single unfitting condition: “Chronic bilateral knee pain, with onset the second week of basic training in November 2001.” The knee pain condition was coded 5099-5003 and rated at 0%. In contrast, the VA unbundled the two knees and rated each knee at 10%. The Board evaluated whether or not it was appropriate for the two knees to be “bundled” together. The Board must determine if the PEB’s approach of combining the conditions under a single rating was justified in lieu of separate ratings. The Board must apply separate codes and ratings in its recommendations if compensable ratings for each condition are achieved IAW the VA Schedule for Rating Disabilities (VASRD) §4.71a. If the Board judges that two or more separate ratings are warranted, however, it must satisfy the requirement that each ‘unbundled’ condition was separately unfitting. After due deliberation, the Board agreed that the evidence supports a conclusion; that the chronic painful condition in each knee, separately, would have rendered the CI unable to perform his required military duties. Accordingly, the Board recommends a separate disability rating for each knee.

The painful knee condition was essentially non-compensable based on the VASRD §4.71a diagnostic codes for loss of knee motion (5260 and 5261). However; IAW VASRD §4.40, §4.45, and §4.59, when part of the musculoskeletal system becomes painful on use, it must be regarded as seriously disabled. A 10% rating is warranted when there is satisfactory evidence of functional limitation due to painful motion of a major joint. There was no path to a rating higher than 10% for either knee since there was no evidence of ligamentous instability, subluxation, locking, or other significant joint abnormality. 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 chronic unfitting right knee pain and a rating of 10% for chronic unfitting left knee pain.


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. PEB reliance on the USAPDA pain policy may have been operant in this case and the condition was adjudicated independently of that policy by the Board. In the matter of the chronic bilateral knee pain, the Board unanimously recommends that each joint be separately adjudicated as follows: an unfitting right knee condition coded 5299-5260 and rated 10%, and an unfitting left knee condition coded 5299-5260 and rated 10%, IAW VASRD §4.40, §4.45, §4.59, and §4.71a. There were no other conditions within the Board’s scope of review for consideration.
RECOMMENDATION: The Board, therefore, recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

UNFITTING CONDITION VASRD CODE RATING
Chronic right knee pain 5299-5260 10%
Chronic left knee pain 5299-5260 10%
COMBINED (w/ BLF) 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131025, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record








                 
XXXXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXXXX, AR20150002595 (PD201302387)
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 20% 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:

Encl                                                  XXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)

CF:
( ) DoD PDBR
( ) DVA

Similar Decisions

  • AF | PDBR | CY2013 | PD2013 00648

    Original file (PD2013 00648.rtf) Auto-classification: Approved

    There was evidence of degenerative changes on X-rays of both knees and, by report in the C&P, evidence of meniscal tears bilaterally on MRI. The profile was for bilateral knee pain, although the commander noted that the CI was limited secondary to pain in his right knee. The CI had positive DeLuca findings for both knees on the VA C&P examination, an abnormal gait secondary to left knee pain on the NARSUM examination and was noted by his commander to have duty restrictions secondary to...

  • 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 | CY2012 | PD2012 01228

    Original file (PD2012 01228.rtf) Auto-classification: Approved

    The MEB forwarded bilateral retropatellarpain syndrome (RPPS)and lateral patellar compression syndrome condition to the Physical Evaluation Board (PEB) IAW AR 40-501. Post-Separation) ConditionCodeRatingConditionCodeRatingExam Bilateral Retropatellar Pain Syndrome S/PArthroscopic Release with only Moderate Improvement5099-50030%Right Knee Patellar Compression Syndrome w/History of Arthroscopic Lateral Release5299-526210%20020429Left Knee Patellar Compression Syndrome w/History of...

  • AF | PDBR | CY2013 | PD-2013-01985

    Original file (PD-2013-01985.rtf) Auto-classification: Approved

    RATING COMPARISON : Service IPEB – Dated 20050224VA -Based on Service Treatment Records(STR)ConditionCodeRatingConditionCodeRatingExam Chronic Bilateral Knee Pain Secondary To Osgood-Schlatter Disease5099-50030%Osgood-Schlatter Disease, Left Knee5299-526010%STROsgood-Schlatter Disease, Right Knee5299-526010%STROther Conditions in Scope x 0Other x 6 Combined: 0%Combined: 20%Derived from VA Rating Decision (VARD)dated 20050526 ( most proximate to date of separation [DOS]). BOARD FINDINGS :...

  • 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 | 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-2013-02760

    Original file (PD-2013-02760.rtf) Auto-classification: Approved

    All treatment notes in the STR addressed the two knees together and the MEB forwarded bilateral knee pain as not meeting retention standards.The Board agreed that the evidence in record reasonably supports that each knee was unfitting at the time of separation and eligible for service 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 | CY2013 | PD-2013-01854

    Original file (PD-2013-01854.rtf) Auto-classification: Denied

    The MEB physical exam performed 5 months prior to separation noted tenderness to external rotation of the right hip joint, otherwise full ROM of both hips. Bilateral Knee Pain During the CI’s first period of service, he developed bilateral knee pain, underwent surgery on his left knee, and was medically separated for bilateral knee pain in 1999. Right Ankle Condition .

  • AF | PDBR | CY2012 | PD 2012 01001

    Original file (PD 2012 01001.txt) Auto-classification: Approved

    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. After due deliberation, considering all of the evidence and mindful of VASRD§ 4.3 (Resolution of reasonable doubt), 4.7 (Higher of two evaluations) and §4.45 (The joints); the Board recommends that the bilateral knee condition be rated for two separate unfitting conditions as...

  • AF | PDBR | CY2012 | PD2012-00333

    Original file (PD2012-00333.docx) Auto-classification: Approved

    The Physical Evaluation Board (PEB) adjudicated the chronic bilateral knee pain condition as unfitting, rated 10%, with application of the US Army Physical Disability Agency (USAPDA) pain policy. The Board noted that PEBs often combine multiple conditions under a single rating when those conditions considered individually are not separately unfitting and would not cause the member to be referred into the DES or be found unfit because of physical disability (DoDI 1332.38, paragraph...