Search Decisions

Decision Text

AF | PDBR | CY2013 | PD-2013-02688
Original file (PD-2013-02688.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

invalid font number 31502 NAME: invalid font number 31502 XXXXXXXXXXXXXXXXXXXX invalid font number 31502        invalid font number 31502 CASE: PD invalid font number 31502 -2 invalid font number 31502 013 invalid font number 31502 -02688 invalid font number 31502
invalid font number 31502 BRANCH OF SERVICE: invalid font number 31502 AIR FORCE invalid font number 31502      invalid font number 31502 BOARD invalid font number 31502 DATE: 201 invalid font number 31502 5 invalid font number 31502 0605 invalid font number 31502
invalid font number 31502 Separation Date: invalid font number 31502 20071029 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 ( Aerospace Control and Warning Systems Specialist) medically separated for bilateral knee pain. The condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty (AFS) or satisfy physical fitness standards. She was issued a temporary P4L2 profile and referred for a Medical Evaluation Board (MEB). The “ chronic knee pain” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123 . No other condition was submitted by the MEB. The Informal PEB (IPEB) adjudicated the c hronic bilateral knee pain as unfitting, rated 10%, c iting application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION : “I have knee pain and/or weakness every days, some days giving me very limited mobility.” [Sic]


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 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 20070911
 VA* - (~1 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Bilateral Knee Pain, Patellofemoral Pain Syndrome 5099-5003 10% Patellofemoral Syndrome, Right Knee 5099-5019 10% 20071128
Patellofemoral Syndrome, Left Knee 5099-5019 10% 20071128
Other x 1 (Not In Scope)
 Other x 7
RATING: 10%
 RATING: 70%
*Derived from VA Rating Decision (VARD) dated 20080312 (most proximate to date of separation (DOS) ) . invalid font number 31502


ANALYSIS SUMMARY :

Chronic Bilateral Knee Pain, Patellofemoral Pain Syndrome . The CI developed progressively worsening bilateral knee pain , the left greater than right, in March 2003. She reported pain worsen ed with strenuous activity and stair climbing . A bilateral knee X- ray performed May 2003 was normal. The CI had physical exam ination findings of bilateral knee crepitus and pain with palpation and range-of-motion (R OM). In June 2003 , the physical therapist (PT) diagnosed bilateral patellofemoral pain syndrome and initiated an extensive treatment program. A left knee magnetic resonance imaging ( MRI ) study done in June 2003 was negative. The o rt h opedist in December 2003 noted chronic bilateral knee pain, swelling , giv ing away, trace effusion , and quadriceps atrophy. The CI underwent a left knee arthroscopy with lateral release on 26 April 2007. The CI resumed PT for post-operative recovery of the left knee and right knee treatment for pain in May 2007. Despite being compliant with all PT treatment regimes, the CI still reported bilateral knee pain and evidence of bilateral muscle weakness and pain with activity. The MEB narrative summary (NARSUM) exam ination performed approximately 3 months prior to separation documented that the CI received no benefit from her left knee surgery and that the surgeon did not want to operate on the right knee given her poor results with the left knee. The CI reported difficulty with any type of running or biking activities more than 20 minutes and carrying loads up stairs. There was no physical exam ination of the knees performed. The CI was given a temporary P4L2 profile with additional restrictions of n o sit-ups, no push-ups, no running, no cycle ergometry, no marching, crawling , and no MOPP gear. The CI was to perform administrative duty only. She was unable to PCS or deploy. The commander’s statement indicated that the CI was unable to perform any du ty which required more than an hour of standing or lifting and her profile restricted her from most phases of the fitness testing.

The VA Compensation and Pension (C&P) exam ination completed approximately a month after separation documented that the CI reported walking with a limp that favored the left kne e; bilateral knee pain ; and swelling with repetitive motion, worse in the left knee. The functional limitations were an inability to stand over 30 minutes without needing to sit-down before her knees would give out. There were physical exam ination findings of limited ROM flexion to 128 degrees (140 degrees normal) on the left knee , 125 degrees on the right , bilateral moderately severe crepitus, bilateral patellar tenderness , and painful joint motion.
The Board directed attention to its rating recommendation based on the above evidence. As noted above, the PEB adjudicated the bilateral patellofemoral pain syndrome as unfitting with a 10% rating as a single disability; coded 5099-5003 (analogous to degenerative arthritis). The VA rated each knee separately at 10%; coded 5099-5019 (analogous to Bursitis). The Board first considered if the each knee having been un coupled from the combined rating could be reasonably justified as independently unfitting. The Board noted that multiple treatment note s evidenced reports of pain in both knees which was well documented throughout the service treatment record and rarely complained of pain in any single knee joint. Both knees were profiled and there are no unilateral distinctions with regards to clinical features or fitness considerations. M embers agreed that the each knee independently would have rendered the CI incapable of continued service within her training for her AFS , is separately unfitting, and that identical coding and ratings are applicable. The Board noted that exam ination s most proximate to separation documented pain-limited knee motion. The Board determined that there was satisfactory evidence of painful motion limitation of motion for a 10% rating for each knee under 5003 . There was no evidence of instability, current meniscal injury, or compensable ROM without application of VASRD §4.59, Painful motion that would not have resulted in a higher than 10% rating for each knee. 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 each knee for a combined 20% rating; coded 5099-5003 IAW VASRD §4.71a and §4.59.
invalid font number 31502
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 c hronic b ilateral k nee pain, patellofemoral pain syndrome condition, the Board unanimously determined that each knee was separately unfitting and recommends a 10% rating for each knee for a combined rating of 20% , IAW VASRD §4.71a. There were no other conditions within the Board’s scope of review for consideration.

invalid font number 31502
invalid font number 31502 RECOMMENDATION invalid font number 31502 : invalid font number 31502 invalid font number 31502 The Board recommends that the CI’s prior determination be modified as follow invalid font number 31502 s, effective as of the date of invalid font number 31502 her prior medical invalid font number 31502 separation: invalid font number 31502 invalid font number 31502

UNFITTING CONDITION VASRD CODE RATING
Patellofemoral Syndrome, Left Knee 5099-5003 1 0%
Patellofemoral Syndrome, Right Knee 5099-5003 10%
COMBINED (w/ BLF) 2 0%
invalid font number 31502

The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20 131217 , w/atchs
Exhib it B. Service Treatment Record
Exhibit C. D epartment of Veterans Affairs Treatment Record







XXXXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review


SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

Dear XXXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2013-02688.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities. Accordingly, the Board recommended modification of your assigned disability rating without re-characterization of your separation with severance pay.

I have carefully reviewed the evidence of record and the recommendation of the Board. I concur with that finding, accept their recommendation and direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force. The office responsible for making the correction will inform you when your records have been changed.

Sincerely,







XXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings

cc:

SAF/MRBR

Similar Decisions

  • AF | PDBR | CY2014 | PD-2014-01186

    Original file (PD-2014-01186.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. 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. Bilateral 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-2014-00701

    Original file (PD-2014-00701.rtf) Auto-classification: Approved

    Pre-Separation)ConditionCodeRatingConditionCodeRatingExam Chronic Bilateral Knee Pain due to RPS5009-50030%RPS Right Knee526010%20030403RPS Left Knee526010%20030403Other x0Other x920030403 Combined: 0%Combined: 60%Derived from VA Rating Decision (VARD)dated 20030725(most proximate to date of separation [DOS]) ANALYSIS SUMMARY :The PEB combined the right and left knee conditions under a single Service disability rating, coded analogously to 5003. After due deliberation in consideration of...

  • AF | PDBR | CY2013 | PD-2013-01846

    Original file (PD-2013-01846.rtf) Auto-classification: Approved

    Post-Separation) ConditionCodeRatingConditionCodeRatingExam Bilateral Knee Pain5099-50030%Left Knee Degenerative Joint Disease5010-526010%20050430Right Knee Degenerative Joint Disease5010-526010%20050430Other x 4 (Not in Scope)Other x 320050503 Combined: 0%Combined: 30%Derived from VA Rating Decision (VARD)dated 20050608 ( most proximate to date of separation) ANALYSIS SUMMARY :The Board’s authority as defined in DoDI 6040.44, resides in evaluating the fairness of Disability Evaluation...

  • 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 | 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 | CY2014 | PD 2014 00376

    Original file (PD 2014 00376.rtf) Auto-classification: Denied

    The rating for the unfitting right knee is addressed below; no additional conditions (the contended left knee, arthritis, nerve damage, GERD and hiatal hernia) are not within the DoDI 6040.44 defined purview of the Board. The examiner opined that theCI’s history of prior knee surgery was most likely exacerbated by the fall.The MEB NARSUM physical exam findings are summarized in the chart below.The VA Compensation and Pension (C&P) exam performed on 3 August 2005,10 months after separation,...

  • AF | PDBR | CY2014 | PD-2014-00232

    Original file (PD-2014-00232.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. Post-Separation)ConditionCodeRatingConditionCodeRatingExam Left Knee Pain PFPS5099-50030%Incomplete Tear, Left ACL, Left Knee5299-52620%20080328Other x0Other x3(Not in Scope) Combined: 0%Combined: 10%*Derived from VA...

  • AF | PDBR | CY2014 | PD 2014 01158

    Original file (PD 2014 01158.rtf) Auto-classification: Denied

    No other conditions were submitted by the MEB.The Informal PEB adjudicated “chronic right knee pain due to patellofemoral syndrome”as unfitting, rated 10%,referencing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).The CI made no appeals and was medically separated. RECOMMENDATION : The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination. I have carefully reviewed the evidence of record and the...

  • AF | PDBR | CY2013 | PD2013 00659

    Original file (PD2013 00659.rtf) Auto-classification: Denied

    The requested hearing loss condition was not identified by the MEB or PEB, and thus is not within the DoDI 6040.44 defined purview of the Board. invalid font number 31502 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.As discussed above, provisions relied upon by the BCMR reliance on an...