Search Decisions

Decision Text

AF | PDBR | CY2013 | PD2013 02438
Original file (PD2013 02438.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX         CASE: PD1302438
BRANCH OF SERVICE: Army  BOARD DATE: 20140807
SEPARATION DATE: 20050319


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve Troop Unit, active drilling, SGT/E-5 (75H20/Personnel Services Specialist) medically separated for right ankle and right knee conditions. The conditions could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards. She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The right ankle and right knee conditions, characterized as “right ankle anterior synovial impingement fibrosis with chronic tibiotalar joint pain status post debridement of capsular scar tissue” and “right knee bursitis,” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The Informal PEB adjudicated “chronic pain right ankle post surgery” and “bursitis of right knee without significant limitation of motion” as unfitting, rated 10% and 0% respectively, citing the US Army Physical Disability Agency (USAPDA) pain policy. The CI made no appeals and was medically separated.


CI CONTENTION: The CI elaborated no specific contention in her application.


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 right ankle and right knee conditions are addressed below; 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 Military Records.


RATING COMPARISON :

Service IPEB – Dated 20050211
 VA - (1 Mo.Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Pain Right Ankle… 5099-5003 10% Right Ankle Disability 5010 10% 20050425
Bursitis Right Knee… 5019 0% Right Knee Bursitis 5019 10% 20050425
No Additional MEB/PEB Entries in Scope
 Other x 4 20050425
Combined: 10%
 Combined: 40%
Derived from VA Rating Decision (VA RD ) dated 200 61017 ( most proximate to date of separation [ DOS ] ).


Right Ankle Condition. The narrative summary (NARSUM) dated 31 January 2005 noted the CI injured her right ankle during mobilization readiness training in January 2004. Initial routine X-rays were normal. Despite conservative treatment a persistent painful condition developed. Magnetic resonance imaging (MRI) of the ankle performed in July 2004 revealed only some inflamed tissue within the ankle joint but without definite injury. To further define the source of the ankle pain a diagnostic arthroscopy was performed in August 2004. Some inflamed tissue (synovium) of the lining of the ankle joint was encountered and removed. Post-operatively, the CI had continued ankle pain. A bone scan performed on 10 December 2004 revealed minor arthritic changes in both ankles and the left great toe. With the cause of the ankle pain still undefined, a complete rheumatology evaluation was undertaken to rule out a systemic cause. This evaluation was unrevealing, but the CI was treated empirically with anti-metabolic agents. At the MEB NARSUM evaluation on 31 January 2005, 2 months prior to separation, the CI reported right ankle pain aggravated by walking, prolonged standing and cold weather. On physical exam, the CI had a noticeable limp. Ankle pain was present on plantar flexion, right dorsiflexion, inversion and eversion. No range-of-motion (ROM) exam was performed. At the VA Compensation and Pension (C&P) exam performed a month after separation, the CI reported constant ankle pain with flare-ups two to three times a month. On examination the CI walked with a limp of the right foot. Tender swelling was present around the right ankle, spreading into the right foot. ROM exam revealed dorsa-flexion of 10 degrees (normal 20 degrees) and plantar flexion of 10 degrees (normal 45degrees), both with pain. X-rays of the right ankle were normal.

The Board directs attention to its rating recommendation based on the above evidence. The PEB rated the ankle condition 10% for pain, coded 5003 (arthritis) and the VA rated it 10% coded 5010 (traumatic arthritis). No higher rating is available under either coding. The Board considered a rating under code 5271, limitation of motion, but unanimously agreed the record in evidence supported no higher rating than 10% under this code. The Board also agreed that the record in evidence supported no rating under codes 5270, ankle ankylosis, or code 5273, malunion. The Board found no other appropriate codes for consideration. 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 ankle condition.

Right Knee Condition. The CI developed a painful right knee in 2004. History of etiology is conflicted in the record which contains reports of injuring the knee during door breach training at the time of the ankle injury and, slipping in a shower and waking up one morning with pain without trauma. MRI of the knee on 16 August 2004 demonstrated no bone, meniscal or ligament injury and only some soft tissue edema. A physical therapy exam on 6 January 2005 reported painful knee motion. The CI was unable to rise from a squatting position because of knee and ankle pain. On exam, tenderness around the knee cap was present. ROM of the knee was flexion of 110 degrees (normal 140 degrees) and normal extension. No instability was reported. Motor strength was decreased in the knee secondary to pain. At the MEB NARSUM evaluation on 31 January 2005, 2 months prior to separation, the CI reported continued knee pain. The MEB physical exam noted only pain with movement of the knee. At the VA C&P exam performed a month after separation, the CI reported limitation of the knee was mainly inability to take long walks. She denied use of crutches or giving way of the knee. On examination, no swelling was noted. Tenderness was present to palpation over the front of the knee. Flexion was 70 degrees with pain; extension was normal. Motor strength was equal in upper and lower extremities and no instability was present.

The Board directs attention to its rating recommendation based on this evidence. The PEB and VA both rated the knee condition using code 5019, bursitis: the PEB at 0%, and the VA at 10%. No higher rating is available under this code. The Board agreed the right knee condition did not rise to the level of 10% for painful motion IAW §4.40 and §4.59. The Board concurred that the record in evidence did not support a rating for limitation of motion under codes 5260 or 5261, or for instability using code 5275. The Board agreed the knee condition was not ratable under codes 5257, or 5562, for knee impairment. The Board found no other appropriate codes for consideration. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends no 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. As discussed above, PEB reliance on the USAPDA pain policy for rating the right ankle condition was operant in this case and all conditions were adjudicated independently of that policy by the Board. In the matter of the right ankle condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. In the matter of the right knee condition, the Board, by a majority vote, recommends no change in the PEB adjudication. The single voter for dissent elected not to submit a minority opinion. 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 20131114, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record








                 
XXXXXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXXXXX , AR20140019483 (PD201302438)

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                                                  XXXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)
                                                     
CF:
( ) DoD PDBR
( ) DVA

Similar Decisions

  • AF | PDBR | CY2012 | PD2012-00635

    Original file (PD2012-00635.pdf) Auto-classification: Approved

    Groin Pain Condition. In the matter of the bilateral hip condition, the Board unanimously recommends that each joint be rated as separately unfitting at 10%, coded 5019, IAW VASRD §4.71a. Service Treatment Record Exhibit C. Department of Veterans Affairs Treatment Record XXXXXXXXXXXXXXXXXX President Physical Disability Board of Review SFMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (TAPD-ZB / ), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 SUBJECT:...

  • AF | PDBR | CY2012 | PD2012 01562

    Original file (PD2012 01562.rtf) Auto-classification: Denied

    The MEB forwarded right shoulder tendonitis/bursitis; status post (s/p) removal of right accessory navicular bone; and posttraumatic left knee pain for Physical Evaluation Board (PEB) adjudication. Right Shoulder Tendonitis/Bursitis Condition . The MEB NARSUM noted TTP and limited, non-compensable ROM on both flexion and abduction of the shoulder.There was no evidence of shoulder instability or dislocation that would allow rating under a shoulder specific Veterans Affairs Schedule for...

  • AF | PDBR | CY2012 | PD2012 01906

    Original file (PD2012 01906.rtf) Auto-classification: Denied

    A third and final MEB in October 2002 forwarded the bilateral knee condition, characterized as bilateral patellofemoral syndrome, status post(s/p) left patellar tendon to the Informal Physical Evaluation Board (IPEB) IAW 1850.4E.The MEB also identified and forwarded left shoulder superior labral tear, s/p arthroscopic repair and left hip greater trochanteric bursitis for IPEB adjudication. The IPEB adjudicated bilateral patellofemoral syndrome (PFS) as unfitting, rated 10%, with application...

  • AF | PDBR | CY2011 | PD2011-00518

    Original file (PD2011-00518.docx) Auto-classification: Denied

    Instability was not noted and ROM was slightly reduced. The IPEB rated the shoulder condition 10% VASRD code 5024, tendinitis, citing a reduced, but not compensable, ROM with pain on the examination performed on 15 April 2008. 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 multiple stress fracture lower extremity condition and,...

  • AF | PDBR | CY2014 | PD-2014-01932

    Original file (PD-2014-01932.rtf) Auto-classification: Approved

    The low back and left knee conditions, characterized as “chronic low back pain” and “patellofemoral pain/chondromalacia patella, left knee,” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.Hypertension and bunionectomy conditions were submitted by the MEB as medically acceptable.The Informal PEB adjudicated “chronic low back pain (LBP) and chronic pain of the left knee”as unfitting, rated 10% and 0% respectively, with likely application of the VA Schedule for Rating...

  • AF | PDBR | CY2012 | PD 2012 01851

    Original file (PD 2012 01851.rtf) Auto-classification: Denied

    SEPARATION DATE: 20030731 At the VA Compensation and Pension (C&P) exam (a month prior to separation), the CI was walking with a brace and had a limp of the right leg. The Board determined that potential codes for the right knee condition could include 5014 (Osteomalacia) or 5024 (Tenosynovitis), but that these would be rated under the same criteria as either code 5003 or 5019 under §4.71a at 10%.The Board considered whether a higher combined rating might be indicated under any other codes...

  • AF | PDBR | CY2014 | PD-2014-00771

    Original file (PD-2014-00771.rtf) Auto-classification: Denied

    One other condition, sleepwalking, was submitted by the MEB.The Informal PEBadjudicated “chronic right hip pain and snapping hip from an iliotibial band syndrome” as unfitting, rated 0%, citing criteria of the Veterans Affairs Schedule for Rating Disabilities (VASRD). Chronic Right Hip Pain Condition . Persistent pain was eventually determined to be due to snapping hip syndrome, a condition resulting from movement of the iliotibial band across the lateral aspect of the hip.

  • AF | PDBR | CY2014 | PD-2014-00467

    Original file (PD-2014-00467.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 theVeterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. 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...

  • AF | PDBR | CY2012 | PD-2012-00692

    Original file (PD-2012-00692.txt) Auto-classification: Approved

    The Physical Evaluation Board (PEB) adjudicated the left hip and lower extremity pain condition as unfitting, rated 0% with likely application of the US Army Physical Disability Agency (USAPDA) pain policy. At the VA Compensation and Pension (C&P) exam prior to separation, the CI reported pain in her low back that radiated into her buttocks which had been diagnosed as left ischial tuberosity syndrome. However, the Board notes the evidence supports primarily left hip exam findings to...

  • AF | PDBR | CY2013 | PD-2013-02815

    Original file (PD-2013-02815.rtf) Auto-classification: Denied

    Orthopedic evaluation diagnosed left snapping hip syndrome and left trochanteric bursitis (inflammation of the hip joint) and the CI had a steroid injection into the left hip with “nearly complete resolution of her symptoms.”The CI had additional hip imaging (MR arthrogram) that supported fibrous dysplasia withno evidence of significant degenerative changes at the left hip or left acetabular labral tear and a new finding of mildinflammation of the gluteal tendon at the hip. RECOMMENDATION :...