Search Decisions

Decision Text

AF | PDBR | CY2014 | PD 2014 00064
Original file (PD 2014 00064.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXX     CASE: PD-2014-00064
BRANCH OF SERVICE: Marine corps  BOARD DATE: 20150106
SEPARATION DATE: 20061031


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty Cpl/E-4 (0811/Artillery Cannoneer) medically separated for right knee pain. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty. He was placed on limited duty and eventually referred for a Medical Evaluation Board (MEB). The right knee condition, characterized by the MEB as two separate diagnoses: “pain in joint, lower leg” and “bucket handle tear of the lateral meniscus,” was forwarded to the Physical Evaluation Board (PEB). No other conditions were forwarded by the MEB. The PEB adjudicated “right medial sided knee pain post surgical” as a Category I condition: unfitting, rated 10%. The PEB found “right knee bucket-handle medial meniscal tear, status post medial meniscectomy” as a Category II condition: a related diagnosis to the unfitting Category I condition. The CI made no appeals and was medically separated.


CI CONTENTION: “Gradual debilitating injury. Pain is worse every year. Arthritis sets faster swelling, weakness. One day I will not be able to walk.”


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 right knee condition is addressed below. The Board will consider the Category II condition as stated above, in its review of the unfitting right knee condition. 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 20060418
 VA - (5 Mos. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Right Medial Sided Knee Pain 5099-5003 10% S/P Right Knee Multiple Surgeries 5260 10% 20060606
Right Knee … Meniscal Tear Cat II S/P Right Tibia Stress Fracture 5299-5262 10% 20060606
Scars, S/P Right Knee Multiple Surgeries 7802 0% 20060606
Other x 0 (Not In Scope)
 Combined: 20%
Combined: 10%
Derived from VA Rating Decision (VA RD ) dated 200 70412 ( most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY: The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him; but must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws. Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.

Right Knee Condition. The service treatment record detailed that the CI was seen for bilateral knee pain (without history of injury) in November 2003. In January 2004 he was seen for a 5 week history of left upper shin pain. X-ray showed a stress fracture of the left [confirmed left, not right] proximal tibia. Two weeks later, the CI reported that the pain had resolved and that he wanted to return to training. In April 2004 he was seen for “right knee out of joint,” although the history for this injury dated back several months. In August 2004 he had arthroscopic reconstruction of the anterior cruciate ligament (ACL) and cartilage repair (medial meniscus) of the right knee. In April 2005 (15 months prior to separation), he reinjured the right knee and had partial resection of the medial meniscus. He underwent extensive physical therapy but had persistent pain and a subtle feeling of instability, although he did not have any frank giveways.

At the NARSUM examination, 8 months prior to separation, the CI had trace swelling of the right knee, tenderness along the medial joint line, and range-of-motion (ROM) from 0 to 120 degrees (normal 0 to 140 degrees). Stability testing indicated “Lachman 1+ translation, 0-5 mm with a solid end point” [mild instability]. At an orthopedic visit 7 months prior to separation, the right knee showed no swelling, full ROM, no laxity (negative McMurray and Lachman signs), and mild tenderness to palpation of the joint line. The examiner stated: “Currently, I think his symptoms of modest instability and medial-sided knee pain are most consistent with the absence of his medial meniscus.”

At the VA Compensation and Pension exam performed 5 months prior to separation, the CI reported intermittent pain over the right proximal tibia (shin bone) for almost 3 years which was aggravated with standing, walking, and running. The pain lasted for a few minutes, was relieved by rest, and did not require pain medication. On examination, there were two surgical scars of the right knee which were “very disfiguring” and “slightly depressed” but without tenderness, tissue loss, ulceration, or keloid (robust scar) formation. There was no crepitus (grating) of either knee and no evidence of laxity (negative Drawer and McMurray tests). The right knee had slight tenderness and limited ROM (0 to 120 degrees, vs. normal 0 to 140 degrees). An X-ray showed a “lucent oblique track in the proximal tibia, as a result of ligamentous repair.” The diagnoses were status-post right tibia stress fracture with ligamentous repair residual recurrent pain and status-post right knee multiple surgeries with residuals of scars and strain.

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the right medical-sided knee pain with code 5099-5003 at 10%, stating that the right knee medial meniscus tear, status-post menisectomy, was a related condition. The VA rated the multiple right knee surgeries with code 5260 (limitation of flexion of leg) at 10%, and the right tibia stress fracture with analogous code 5262 (impairment of tibia and fibula) at 10% (with slight knee or ankle disability). The VARD attributed slight knee disability with recurrent pain with prolonged walking and inability to run to the recurrent to the stress fracture (analogous code 5262), and decreased ROM and tenderness to the knee multiple surgeries (code 5260).

The Board notes that the CI’s stress fracture was of the left tibia (source X-ray and treatment notes) rather than of the right tibia. The radiographic right tibia findings from the VA exam were noted, but not indicative of a stress fracture. Rating of the right knee to include all sources of knee disability (ACL, meniscus, and scars) was discussed by the Board. Limitation of motion did not attain a minimum rating under the diagnostic codes for limitation of flexion (5260) or extension (5261). There was not significant objective evidence of instability of the knee to warrant a separate rating under code 5257 (recurrent subluxation or lateral instability), or for dual rating of the knee. The Board considered that a 10% rating under disability code 5259 (Cartilage, semilunar - meniscus) would be ideal coding of the knee and included all of the CI’s symptoms. There was not sufficient evidence of frequent episodes of “locking” and effusion into the joint that would warrant a higher meniscal rating (under code 5258). There was insufficient evidence of moderate knee disability for higher coding analogously to 5262 (Tibia and fibula impairment). After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board did not find a pathway to a higher rating, and 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 right knee 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 re-characterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131226, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record




                                   
XXXXXXXXXXXXXX
President
DoD 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 29 Apr 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:
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USN


                                                      XXXXXXXXXXXXXX
                                            Assistant General Counsel
                                                      (Manpower & Reserve Affairs)

Similar Decisions

  • AF | PDBR | CY2013 | PD-2013-01316

    Original file (PD-2013-01316.rtf) Auto-classification: Approved

    The lower extremity pain, characterized as “bilateral proximal tibial stress fractures, symptomatic on the right,” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.The Informal PEB adjudicated “chronic lower extremity pain, due to bilateral proximal tibial stress fractures, symptomatic on the right”as unfitting, rated at 0%, citing the US Army Physical Disability Agency (USAPDA) pain policy.The CI made no appeals and was medically separated. In support...

  • AF | PDBR | CY2013 | PD-2013-02796

    Original file (PD-2013-02796.rtf) Auto-classification: Approved

    The physical examination noted normal ROM of the left knee, presence of a scar, and a general comment of “Stable.”The final diagnosis was reported as,“Left knee tibial plateau fracture with ligament injury.”At the MEB NARSUM exam on 6 February 2007, the CI was still using crutches in accordance with the post-operative recovery plan for 8 to 12 weeks of limited weight bearing. Although the ACL and PCL were intact, there was evidence of residual laxity at the time of the PT examination and...

  • AF | PDBR | CY2014 | PD-2014-00024

    Original file (PD-2014-00024.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. Left Knee Condition . The Board agreed the left knee condition had someforward laxity but no lateral instability/subluxation after surgery, given the normal gaits, and findings on examinations proximate to...

  • AF | PDBR | CY2009 | PD2009-00058

    Original file (PD2009-00058.docx) Auto-classification: Approved

    RECOMMENDATION : The Board recommends that the CI’s prior determination be modified as follows and that the discharge with severance pay be recharacterized to reflect disability retirement, effective as of the date of his prior medical separation. malunion with marked right knee disability, VASRD code 5299-5262, rated at 30%, rather than pay; rather, on that date he was released from active duty and on 13 September 2005 his name was

  • AF | PDBR | CY2014 | PD-2014-01771

    Original file (PD-2014-01771.rtf) Auto-classification: Approved

    There was pain during evaluation of ROM and stress of the meniscus. The post separation MRI did not report any abnormality of the PCL and orthopedic examination and arthroscopy did not show any abnormality of the PCL.The Board noted the VA C&P examination report of moderate laxity of the medial collateral ligament upon which the VA based its 20% rating under VASRD code 5257. All Board members agreed that the examinations summarized above reported sufficient evidence of painful motion and...

  • AF | PDBR | CY2009 | PD2009-00653

    Original file (PD2009-00653.docx) Auto-classification: Denied

    The PEB adjudicated the ACL deficient right knee condition as unfitting, and assigned a disability rating of 10%. In the matter of the ACL deficient right knee, the Board unanimously recommends a disability rating of 10%, coded 5299-5003 IAW VASRD §4.71a. I have reviewed the subject case pursuant to reference (a) and, for the reasons set forth in reference (b), approve the recommendation of the Physical Disability Board of Review Mr. XXXXX’s records not be corrected to reflect a change in...

  • AF | PDBR | CY2012 | PD 2012 01521

    Original file (PD 2012 01521.txt) Auto-classification: Approved

    A final PEB revised for an administrative correction dated 18 March 2003 adjudicated the chronic pain, left knee condition as unfitting, rated 0% with application of the US Army Physical Disability Agency (USPDA) pain policy. By rating decision 15 March 2004, the VA rated the condition 30% based on the partial knee replacement surgery after separation (coded 5055). RECOMMENDATION: The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his...

  • AF | PDBR | CY2010 | PD2010-00128

    Original file (PD2010-00128.docx) Auto-classification: Denied

    The CI appealed to the formal PEB (FPEB), which made no rating changes and the CI was medically separated with a 20% disability rating. The VA coded using 5262 (impairment of tibia and fibula) and rated the condition as malunion with marked knee disability. In the matter of the right knee condition, the Board unanimously recommends a rating of 30% coded 5262 IAW VASRD §4.71a.

  • AF | PDBR | CY2014 | PD 2014 01882

    Original file (PD 2014 01882.rtf) Auto-classification: Denied

    The right knee condition, characterized by the MEB as “tricompartmental chondromalacia of the right knee,” “lateral meniscus tear” and “left knee neuroma” (Board believes this to be an error and should have been right knee), were forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. The Informal PEB adjudicated “tricompartmental chondromalacia of the right knee” as unfitting, rated at 10%, with likely application of theVeterans Affairs Schedule for Rating Disabilities...

  • AF | PDBR | CY2011 | PD2011-00494

    Original file (PD2011-00494.docx) Auto-classification: Denied

    Flexion (140⁰ normal)“approximately 0 to 125⁰”100⁰110⁰Extension (0⁰ normal)0⁰0⁰CommentVarus deformity, palpable femoral osteophytes, scar, crepitus, TTP, no instability (including Lachman’s), neg McMurray’s, mildly pos patellar grind3+ effusion, TTP (medial joint line & lat epicondyle), 30 ml normal joint fluid aspirated, steroid injected; Hx incr pain & effusion due to moving over last 2-3 wks, no lockingPainful motion, crepitus, scar nontender, no instability (including Lachman’s), neg...