Search Decisions

Decision Text

AF | PDBR | CY2013 | PD-2013-02698
Original file (PD-2013-02698.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX       CASE: PD-2013-02698
BRANCH OF SERVICE: AIR FORCE     BOARD DATE: 20150409
SEPARATION DATE: 20090627


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6 (Voice Network System, Craftsman) medically separated for an ankle and a knee condition. The conditions could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty or satisfy physical fitness standards. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The “left knee and right ankle pain” were forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123. No other condition was submitted by the MEB. The Informal PEB adjudicated “left knee pain due to degenerative joint disease [DJD]” and “right ankle pain due to degenerative joint disease” as unfitting, rated 10% and 10%, c iting application of the DODI and Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI appealed to the Formal PEB (FPEB) which affirmed the PEB findings and ratings and was medically separated.


CI CONTENTION: “Left knee anterior cruciate reconstruction and degenerative joint disease. Right ankle degenerative joint disease. Lumbago.”


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 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 :

FPEB – Dated 20090406
 VA* - (~2 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Left Knee Pain due to DJD 5009-5003 10% Left Knee Residuals, S/P ACL … 5003-5260 10% 20090831
Right Ankle Pain due to DJD 5009-5003 10% Right Ankle S/P (Surgery) 5271 10% 20090831
Other x 0 (Not In Scope)
 Other x 6
RATING: 20%
 RATING: 40%
* Derived from VA Rating Decision (VA RD ) dated 200 9092 7 (most proximate to date of separation [ DOS ] ) .



ANALYSIS SUMMARY:

Left Knee Pain due to DJD Condition. The narrative summary (NARSUM) and treatment record noted the CI had a left knee injury in 1999 with surgical reconstruction of his anterior cruciate ligament (ACL), repair of a meniscal cartilage tear, and bony repair (femoral condyle microfracture) in April 2007. His knee instability improved, but he continued to have pain and intermittent swelling of his knee. He complained of inability to run and pain on prolonged walking. His rebuttal materials included complaints of “problems with my stability, strength and stamina in my knee” and evidence of duty release to “ice down” his knees and ankle after activities. FPEB testimony indicated intermittent episodes of hyperextension. Radiographs documented tricompartment osteoarthritis. Exam documented normal gait. There was minimal effusion of the knee with range-of-motion (ROM) 0-125 degrees for both knees (normal 0-140). There was a 1+ Lachman’s on the left with a solid endpoint compared with 0 on the right. There was moderate subpatellar crepitus. Other tests of instability were negative (anterior and posterior drawer, varus and valgus stressing) and meniscal tests were negative (McMurray’s and joint line tenderness). Lower extremity strength was normal.

At the VA Compensation and Pension (C&P) exam performed 2 months after separation, the examiner indicated ACL and meniscal repair of the left knee. The CI reported chronic pain, stiffness, and swelling of his left knee. He had no locking and did not wear a brace. He had flares from prolonged standing or walking. Exam documented a left sided limp and the knee had a swollen appearance without effusion, ligament laxity or crepitus. There was “no gross clinical instability” and there was a negative drawer’s sign (stable) and negative McMurray’s sign (meniscus). Extension was to 0 degrees (normal) and flexion to 117 degrees (140 normal) with no further loss on repetition.

The Board directed attention to its rating recommendation based on the above evidence. All exams documented stiffness or pain with limited ROM that was not compensable under the specific knee codes, but warranted a 10% rating IAW VASRD §4.59 (painful motion), §4.40 (functional loss) and §4.45 (the joints). There was no evidence of incapacitating episodes or frequent locking for higher coding under arthritis or meniscal associated coding. The Board deliberated if there was sufficient evidence of instability for dual coding of the knee. The FPEB specifically addressed instability noting the 1+ Lachman test and episodes of hyperextension stating “that if the condition were rated under VASRD Code 5257 it would equate to a slight disability,” but noted that the predominant impairment was “pain due to tricompartmental osteoarthritis” and elected a rating under the criteria of code 5003. VASRD guidance and precedence allows dual ratings of the knee for both instability and painful or pain limited motion. The Board discussed that the FPEB language was a likely application of DODI 1332.39, Para 6.4 for pyramiding rather than application of VASRD §4.14 (avoidance of pyramiding) including the special VASRD guidance on dual ratings of the knees, and/or if there were sufficient evidence to warrant a slight instability (10% under code 5257).

The Board deliberated the probative value of the FPEB testimony and assessment (AF Form 356, item #15 remarks) given scant treatment records proximate to separation and the after separation VA exam which documented no instability. The Board consensus was that the NARSUM, CI’s rebuttal and FPEB had the highest probative value for rating at the time of separation and that given the slight laxity and arthritis with pain-limited motion, the Board majority recommended dual rating of the knee. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), member consensus was that coding under 5257 (knee, other impairment [instability]) as slight at 10%, in addition to coding under 5099-5003 for painful motion at 10% was warranted.

Right Ankle Pain due to DJD Condition. The NARSUM noted a right ankle injury in 1998 and significant worsening of pain and instability in 2007. Imaging documenting degenerative changes and cartilage and bony damage (osteochondral lesions of the talar dome). The CI had ankle surgery in June 2008 (arthroscopy with microfracture and chondroplasty). He was issued an ankle brace. At the NARSUM exam, the CI reported pain limiting his ability to run and walk long distances. Imaging documented evidence of degenerative arthritis. The NARSUM exam noted decrease dorsiflexion of 10 degrees (normal 20) and decreased plantar flexion of 35 degrees (normal 45). There was tenderness with no signs of instability.

At the VA C&P exam performed 2 months after separation, the CI reported continued pain and ankle stiffness with wearing an ankle brace most days. On exam, the CI was wearing his ankle brace (Velcro appliance) and had a slightly wider ankle on the right (by 0.75 inches in circumference). Dorsiflexion was 7 degrees (normal 20) and plantar flexion was 39 degrees (normal 45) with pain and stiffness on motion. There was no further reduction on repetition.

The Board directed attention to its rating recommendation based on the above evidence. All exams documented pain limited ankle motion that would warrant “moderate” limited motion IAW VASRD code 5271. The FPEB coding under 5099-5003 used the same symptoms of pain limited motion and was an acceptable analogous code. There was no ankyloses, no incapacitating periods and insufficient evidence of ankle limitations sufficient to warrant rating as “marked” limitations. Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 10% for the right ankle condition was appropriately recommended in this case.


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, PEB reliance on DODI 1332.39 (para 6.4. Pyramiding) for rating the knee was operant in this case and the condition was adjudicated independently of that instruction by this Board. In the matter of the left knee condition, the Board majority recommends a disability rating of 10%, coded 5257, plus a 10%, coded 5099-5003 IAW VASRD §4.71a. In the matter of the right ankle 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 recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of his prior medical separation:

CONDITION VASRD CODE RATING
Left Knee Pain due to Degenerative Joint Disease 5099-5003 10%
5257 10%
Right Ankle Pain due to Degenerative Joint Disease 5099-5003 10%
COMBINED (w/ BLF) 30%



The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131211 w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department 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-2013-02698 .
         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 your separation be re-characterized to reflect disability retirement, rather than 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 determined that your records should be corrected accordingly. The office responsible for making the correction will inform you when your records have been changed.

         As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP). Upon receipt of this letter, you must contact the Air Force Personnel Center at (210) 565-2273 to make arrangements to obtain an SBP briefing prior to rendering an election. If a valid election is not received within 30 days from the date of this letter, you will not be enrolled in the SBP program unless at the time of your separation, you were married or had an eligible dependent child, in such a case, failure to render an election will result in automatic enrollment.

 Sincerely,





XXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency
Attachment:
Record of Proceedings

cc:
SAF/MRBR
DFAS-IN

Similar Decisions

  • AF | PDBR | CY2011 | PD2011-00832

    Original file (PD2011-00832.docx) Auto-classification: Denied

    The FPEB and VA each coded the individual knees at 10% using the criteria for arthritis (5003), with the VA indicating a traumatic onset by using code 5010. Left Knee : With regards to the left knee, the Board considered that the preponderance of the record supported the 10% rating for the left knee for limited motion. RECOMMENDATION : The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows:

  • 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 | CY2013 | PD-2013-01417

    Original file (PD-2013-01417.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. During repair, the operative report identified Grade 1 chondromalacia (arthritis) with synovitis, and normal medial and lateral menisci.Despite rehabilitation, the CI continued to have knee pain and effusions (swelling...

  • 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 | PD-2013-01822

    Original file (PD-2013-01822.rtf) Auto-classification: Approved

    Bilateral knee degenerative joint disease (DJD), left greater than right and left ankle pain were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. Post-Separation) ConditionCodeRatingConditionCodeRatingExam Degenerative Arthritis of the Knees500310%Degenerative Joint Disease, R Knee5010-526010%20040925Degenerative Joint Disease, L Knee5010-526010%20040925Left Ankle PainNot UnfittingLeft Ankle Sprain5299-52700%20040925Other x 0 (Not in Scope)Other x 6 Rating: 10%Combined:...

  • AF | PDBR | CY2013 | PD-2013-02213

    Original file (PD-2013-02213.rtf) Auto-classification: Approved

    Right Ankle Condition . Post-operatively, he underwent physical therapy and rehabilitation.The CI was issued a permanent L3 profile dated 18 April 2007 for right knee and ankle pain with restrictions as noted above in the right knee condition section.The commander’s statement noted duty limitations from the ankle and knee.At the MEB examination dated 25 May 2007, the CI reported constant pain in the right leg to include his right ankle.The MEB physical examinationof the ankle, the examiner...

  • AF | PDBR | CY2013 | PD-2013-01379

    Original file (PD-2013-01379.rtf) Auto-classification: Denied

    At the MEB NARSUM examination(approximately 3 months prior to separation), the CI reported left hip pain. 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 22202-3557SUBJECT: Department of Defense Physical Disability Board of Review Recommendation forXXXXXXXXXXXXXXXXX, AR20150006430 (PD201301379) I have reviewed the enclosed Department of Defense Physical Disability...

  • 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

  • AF | PDBR | CY2014 | PD-2014-00930

    Original file (PD-2014-00930.rtf) Auto-classification: Denied

    Post-Separation)ConditionCodeRatingConditionCodeRatingExam Chronic Left Knee Pain, Patellofemoral Syndrome, s/p Arthroscopy x25099-500310%Degenerative Arthritis, Left Knee5260-500310%20110803 Internal Derangement, Left Knee5003-525730%20110803Other x0Other x1 RATING: 10%RATING: 40%*Derived from VA Rating Decision (VARD)dated 20120720(most proximate to date of separation [DOS]) Left Knee Pain . After review by a Decision Review Officer, the VA applied two different VASRD codes to the left...

  • AF | PDBR | CY2012 | PD2012-00094

    Original file (PD2012-00094.docx) Auto-classification: Denied

    The PEB adjudicated the left knee DJD condition as unfitting, rated 20%, with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD). 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 fitness determination for the any of the contended conditions; and, therefore, no additional disability ratings can be recommended. In the matter of the left knee condition...