Search Decisions

Decision Text

AF | PDBR | CY2013 | PD-2013-02496
Original file (PD-2013-02496.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2013-02496
BRANCH OF SERVICE: NAVY  BOARD DATE: 20140522
SEPARATION DATE: 20040615


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty IS/E-5 (Navy Tactical Command Systems) medically separated for recurrent left patellar tendinosis. The condition could not be adequately rehabilitated to meet the physical requirements of his rating or satisfy physical fitness standards. He was placed on limited duty and referred for a Medical Evaluation Board (MEB). The recurrent left patellar tendinosis condition was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. No other conditions were submitted by the MEB. The Informal PEB adjudicated “recurrent left patellar tendinosis” as unfitting, rated 10%, w ith likely application of the Department of Defense Instruction (DoDI) 1332.39 and VA Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION: “I have continued pain in my knee and cannot do full physical activity as desired. I also now have pain and issues in right knee because of disability.”


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 ratings for the unfitting recurrent left patellar tendinosis condition is addressed below; and, no additional 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 Naval Records.


 RATING COMPARISON :

Service IPEB – Dated 20040415
 VA - (2 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Recurrent Left Patellar Tendinosis 5099-5003 10% Left Patellar Chondromalacia and Patellar Tendinitis 5099-5010 10% 20040805
Other x 0 (Not in Scope)
 Other x 2 (Not in Scope)
Rating: 10%
 Rating: 10%
Derived from VA Rating Decision (VA RD ) dated 200 50209 ( most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY: The Disability Evaluation System (DES) is responsible for maintaining a fit and vital fighting force. While the DES considers all of the member's medical conditions, compensation can only be offered for those medical conditions that cut short a service member’s career, and then only to the degree of severity present at the time of final disposition. The DES has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation nor for conditions determined to be service-connected by the Department of Veterans Affairs (DVA) but not determined to be unfitting by the PEB. However the DVA, operating under a different set of laws (Title 38, United States Code), is empowered to compensate all service-connected conditions and to periodically re-evaluate said conditions for the purpose of adjusting the Veteran’s disability rating should the degree of impairment vary over time. The Board’s role is confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on severity at the time of separation.

Recurrent Left Patellar Tendinosis Condition. According to service treatment records and the MEB narrative summary (NARSUM), the CI complained of insidious onset of left anterior knee pain beginning in 2000 subsequently diagnosed as patellar tendonosis (degeneration of tendon’s collagen in response to chronic overuse). On 1 October 2001, the CI underwent surgical diagnostic arthroscopy (arthroscope introduced through small incisions in joint to visualize pathology) and open debridement of his left patellar tendon. The CI was returned to full duty and his post-operative left anterior knee pain symptoms continued to wax and wane. After extensive physical therapy the CI never completely improved. X-rays studies obtained in December 2003 were essentially unremarkable, but a magnetic resonance imaging showed a recurrence of his patellar tendonosis (per MEB NARSUM). At the time of the MEB NARSUM on 11 March 2004, he denied significant relief of symptoms and complained of pain with kneeling, squatting, prolonged sitting, standing and climbing ladders. The physical examination showed a well healed left knee surgical incision. The CI had normal muscle tone, normal muscle bulk, ligamentous stability, intact neurovascular status, and “full active range-of-motion.” He had exquisite tenderness over the inferior pole of his patellar tendon. He displayed mildly positive patellar grind and quadriceps inhibition tests without apprehension or crepitus. The 25 March 2004 non-medical assessment indicated that the CI was limited by the severe knee pain condition and had significant difficulty getting up after prolonged sitting. At the 5 August 2004 VA Compensation and Pension examination, 6 weeks after separation, the CI reported that he injured his left knee in 1999 while climbing/descending ladders and running on decks. The CI complained of chronic (daily) left knee stiffness and pain in the area of the patella and patellar tendon. He reported it was worse with squatting, kneeling, climbing/descending stairs and cold temperatures. He complained that the pain was exacerbated with walking more than 30 to 45 minutes, running more than 30 minutes, biking more than 20 minutes, or sitting more than 2 hours. He could carry out all his activities of daily living and did not lose time from work related to his knee symptoms. He did not wear a knee brace. The physical examination documented normal posture and gait. The extremities showed no signs of abnormal weight bearing. The knee examination revealed a healed surgical scar. The knees showed no heat, redness, swelling or effusion (abnormal collection of fluid in the joint). There was no subluxation or locking. Both knees had a range-of-motion of flexion to 120 degrees and extension to 0 degrees without pain, fatigue, weakness, incoordination, or lack of endurance. Tests for instability (drawer tests) and meniscus pathology (McMurray's tests) were negative. The patient had left retropatellar grinding with negative patellar apprehension. A 5 August 2004 left knee X-ray was read as normal.

The Board directs attention to its rating recommendation based on the above evidence. The PEB rated the left knee condition 10% (VA SRD code 5099-5003; disability rating by analogy-degenerative arthritis) . The VA also rated the knee condition 10% (VA code 5099-5010; disability rating by analogy-traumatic arthritis) citing painful motion. The limitation of motion documented in examinations did not attain a minimum rating under the VASRD diagnostic codes for limitation of flexion (5260) or extension (5261). Board members agreed that there was sufficient evidence of pain with use prior to separation, as well objective examination and imaging findings, to support a 10% rating considering functional loss and painful motion ( § 4.40, § 4.59) . The facts support a 10% rating under VASRD diagnostic code 5003 for degenerative arthritis selected by the PEB or the 5010 code for traumatic arthritis selected by the VA. There was no dislocated meniscus for consideration under 5258 (dislocated meniscus with frequent episodes of locking) . There was no instability for rating consideration under 525 7 (recurrent subluxation or instability). There was no ankylosis of the knee for consideration under 5256 ( k nee, ankylosis of). 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 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. 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 recurrent left patellar tendinosis 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 recharacterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20130813, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record



                 
XXXXXXXXXXXXXXX
President
Physical Disability Board of Review
MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
BOARDS

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

Ref: (a) DoDI 6040.44
(b) CORB ltr dtd 26 Feb 15

In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USN


                                                      XXXXXXXXXXXXXXX
                                            Assistant General Counsel
                  (Manpower & Reserve Affairs)

Similar Decisions

  • AF | PDBR | CY2014 | PD 2014 00096

    Original file (PD 2014 00096.rtf) Auto-classification: Denied

    The left knee condition, characterized as “chondromalacia of patella,” “tear of medial cartilage or meniscus of knee,” “pain in joint involving lower leg” and “unspecified orthopedic aftercare” were forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. Post-SepFlexion (140 Normal)115105Extension (0 Normal)-0Commentantalgic gait; crepitus;painful motion; antalgic gait§4.71a Rating10%10%The Board directs attention to its rating recommendationbased on the above...

  • AF | PDBR | CY2014 | PD-2014-00344

    Original file (PD-2014-00344.rtf) Auto-classification: Denied

    SEPARATION DATE: 20060405 Left Knee Condition . By the time of separation, the CI’s condition had improved such that he had a full ROM, albeit that knee pain persisted in spite of treatment.

  • AF | PDBR | CY2012 | PD2012-00402

    Original file (PD2012-00402.pdf) Auto-classification: Denied

    The CI underwent the first MEB exam for bilateral lower leg pain. Alternative coding using the VA rating separating the tendinosis from the Morton neuroma disabilities was also considered reasonable, but would also raise the military- 3 PD1200402 specific issue of fitness when the NARSUM did not specify duty impairment from any mid, or distal foot condition. RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation...

  • AF | PDBR | CY2013 | PD-2013-01259

    Original file (PD-2013-01259.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. Three months after separation, the VA rated the knee at 10% for retropatellar pain syndrome (coded 5261).The service treatment record(STR) did not document any compensable ROM impairment under the specific knee codes; however, the MEB, NARSUM, and VA C&P all documented...

  • AF | PDBR | CY2014 | PD-2014-03635

    Original file (PD-2014-03635.rtf) Auto-classification: Approved

    The Informal PEB adjudicated “chronic pain right knee, dueto patellofemoral syndrome” as unfitting, rated 0%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).The remaining condition was determined to be not unfitting. 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...

  • AF | PDBR | CY2013 | PD-2013-01519

    Original file (PD-2013-01519.rtf) Auto-classification: Approved

    RATING COMPARISON : Service IPEB – Dated 20040604Based on Service Treatment Records(STR)ConditionCodeRatingConditionCodeRatingExam Bilateral Knee Pain5099-50030%Residuals, Medial Meniscus Tear526210%STROther x 0 (Not in Scope)Other x 0 Combined: 0%Combined: 10%Derived from VA Rating Decision (VARD)dated 20060518(most proximate to date of separation) ANALYSIS SUMMARY : Bilateral Knee Pain Condition . The Board directed attention to its rating recommendationbased on the above evidence.The PEB...

  • AF | PDBR | CY2014 | PD-2014-01877

    Original file (PD-2014-01877.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 Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. Bilateral Knee Pain Condition . 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...

  • AF | PDBR | CY2013 | PD-2013-01562

    Original file (PD-2013-01562.rtf) Auto-classification: Approved

    Pre-Separation) ConditionCodeRatingConditionCodeRatingExam Left Knee Pain5099-50030%Degenerative Changes Left Knee5260-501010%20040915Other x 0 (Not in Scope) Combined: 0%Combined: 20% *Derived from VA Rating Decision (VARD)dated 20041230(most proximate to date of separation (DOS)) Left Knee Pain with Chondromalacia Grade 1/2 Condition . At the MEB exam, 6 months prior to separation, the CI reported continuing left knee pain and recurrent episodes of locking. BOARD FINDINGS : IAW DoDI...

  • AF | PDBR | CY2012 | PD-2012-00433

    Original file (PD-2012-00433.pdf) Auto-classification: Denied

    The MEB referenced a visit to orthopedic surgery in December 2008, 8 months prior to separation, which diagnosed patellofemoral dysfunction and recommended medically separating the member if she did not improve with quadriceps rehabilitation at physical therapy (PT). The VA 40% rating indicated a significantly more limited extension based on the C&P exam interpretation of ‐30 degrees limited extension. After due deliberation, considering all of the evidence and mindful of VASRD §4.3...

  • AF | PDBR | CY2012 | PD2012-00065

    Original file (PD2012-00065.docx) Auto-classification: Denied

    The other requested conditions (the remaining conditions rated by the VA at separation) are not within the Board’s purview. *** VARD 20091015 awarded a temporary 100% rating based on surgical or other treatment necessitating convalescence, effective 20090916 to 20100101. The MEB examination performed 5 months prior to separation indicated chronic left knee swelling and tenderness.