Search Decisions

Decision Text

AF | PDBR | CY2014 | PD 2014 00229
Original file (PD 2014 00229.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXX     CASE: PD-2014-00229
BRANCH OF SERVICE: MARINE CORPS  BOARD DATE: 20141016
SEPARATION DATE: 20060416


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty CPL/E-4 (3531/Motor Transport Operator) medically separated for disruption of posterior cruciate ligament. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards. He was placed on limited duty and referred for a Medical Evaluation Board (MEB). Health examination of defined subpopulation and unspecified internal derangement of knee were forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. No other conditions were submitted by the MEB. The Informal PEB adjudicated “disruption of posterior cruciate ligament (PCL) treated with reconstruction, with symptomatic right knee laxity” as unfitting, rated 10% with likely application of the VA Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION: “PCL restruction. [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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI. The rating for the unfitting disruption of posterior cruciate ligament condition is addressed below; no additional conditions are within the DoDI 6040.44 defined purview of the Board. Any condition 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 20060214
 VA* - (2 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Disruption of Posterior Cruciate Ligament…with Symptomatic Right Knee Laxity 5262 10% Right Knee Laxity 5257 10% 20060215
Status Post Right Knee Posterior Cruciate Ligament Reconstruction 5260 10% 20060215
Other x 0 (Not in Scope)
 Other x 3 (Not in Scope) 20060215
Combined: 10%
 Combined: 20%
* Derived from VA Rating Decision (VA RD ) dated 200 60515 (most proximate to date of separation ( DOS ) )


ANALYSIS SUMMARY:

Disruption of Posterior Cruciate Ligament (PCL) Condition. A treatment note dated 29 September 2004 documented right knee pain and instability for a month after a right knee injury. The CI was referred for a magnetic resonance imaging (MRI) study and physical therapy. The MRI revealed a PCL tear. The CI underwent a right knee PCL reconstruction on 31 March 2005. The operative note documented restoration of firm posterior stability. The CI underwent a post-operative course of physical therapy. At an orthopedic evaluation 6 months after the surgery, the CI denied frank instability, but reported weakness “after walking and running a while.” Testing for instability revealed mild instability with a firm PCL endpoint. The examiner diagnosed an old disruption of PCL with symptomatic laxity. The examiner opined that further reconstruction was not indicated and recommended a sedentary job. The narrative summary examination dated 14 November 2005 documented reports of continued weakness and sensations of giving way of the right knee without frank instability. The physical examination was significant right knee anterior and PCL instability. There was no tenderness. The examiner noted that the combination of anterior cruciate ligament and PCL laxity resulted in significant anteroposterior instability. The examiner rendered a diagnosis of symptomatic right knee laxity.

At a VA internal medicine evaluation dated 15 February 2006, 2 months prior to separation, the CI reported right knee pain with weakness. He reported constant pain rated 2 on a scale of one to 10. He was unable to run. Physical examination demonstrated evidence of limited and painful motion and laxity of the medial collateral ligament. The examiner identified instability as having the major functional impact, but noted pain, incoordination and instability with repetitive use. At the VA Compensation and Pension examination performed 12 months after separation, the CI reported right knee weakness, swelling, and giving out. He reported constant burning pain rated 2/10. The instability and pain prevented him from performing high impact activities, prolonged standing, and walking.

The Board directs attention to its rating recommendation based on the above evidence. The PEB adjudicated the disruption of PCL treated with reconstruction, symptomatic right knee laxity as unfitting with a disability rating of 10%, coded 5262 (tibia and fibula impairment). VA assigned a 10% rating for the right knee for instability, coded 5257 (knee impairment) and 10% for painful motion, coded 5260 (leg limitation of flexion). The Board considered that evidence of instability and pain with use were evidenced in multiple treatment notes and VA examinations. This case justifies Board consideration of separate ratings for instability and painful motion as established by formal VA policy in effect at the time of separation (General Counsel Opinion of 1 July 1997 and Fast Letter 04-22 of 1 October 2004). By prior legal opinion and firm precedent, the Board adheres to this guidance. 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 the right knee laxity condition and IAW VASRD §4.59 (painful motion) 10% for right knee painful motion; a combined disability rating of 20%.


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 laxity condition, the Board unanimously recommends a disability rating of 10%, coded 5257 and 10% for painful motion, coded 5299-5260, for a combined rating of 20%, IAW VASRD §4.71a and §4.59. 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, effective as of the date of his prior medical separation:

UNFITTING CONDITION VASRD CODE RATING
Right Knee Laxity 5257 10%
Right Knee status post Posterior Cruciate Reconstruction 5299-5260 10%
COMBINED 20%
The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20 1 40103 , w/atchs
Exhib it B. Service Treatment Record
Exhibit C. Department of Veterans ’ Affairs Treatment Record






                 
XXXXXXXXXXXXXX
President
Physical Disability Board of Review


 MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND
                  DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS
        
Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

Ref: (a) DoDI 6040.44
(b) PDBR ltr dtd 14 Apr 15 ICO XXXXXXXXXXXXXXX
         (c) PDBR ltr dtd 7 Apr 15 ICO XXXXXXXXXXXXXXX
         (d) PDBR ltr dtd 14 Apr 15 ICO XXXXXXXXXXXXXXX
         (e) PDBR ltr dtd 14 Apr 15 ICO XXXXXXXXXXXXXXX
(f) PDBR ltr dtd 21 Apr 15 ICO XXXXXXXXXXXXXXX

1. Pursuant to reference (a) I approve the recommendations of the Physical Disability Board of Review set forth in references (b) through (f).

2. The official records of the following individuals are to be corrected to reflect the stated disposition:

a. XXXXXXXXXXXXXXX, former USN : Entitlement to disability severance pay with a disability rating of 20 percent (increased from 10 percent) effective date of discharge.

b. XXXXXXXXXXXXXXX, former USMC : Entitlement to disability severance pay with a disability rating of 20 percent (increased from 0 percent) effective date of discharge.

c. XXXXXXXXXXXXXXX, former USMC : Entitlement to disability severance pay with a disability rating of 20 percent (increased from 10 percent) effective date of discharge.

d. XXXXXXXXXXXXXXX, former USMC : Entitlement to disability severance pay with a disability rating of 10 percent (increased from 0 percent) effective date of discharge.

e. XXXXXXXXXXXXXXX, former USN : Retroactive placement on the Temporary Disability Retired List with a disability rating of 50 percent for the 6 months immediately preceding discharge followed by disability separation effective date of discharge with a 10 percent disability rating.

3. Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are completed.



          XXXXXXXXXXXXXXX
         Assistant General Counsel
                 (Manpower & Reserve Affairs)

Similar Decisions

  • 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 | CY2014 | PD-2014-00812

    Original file (PD-2014-00812.rtf) Auto-classification: Denied

    No other conditions were submitted by the MEB.The PEB adjudicated “anterior right knee pain secondary to posterior cruciate ligament (PCL) tear”as unfitting, rated 20%with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).The CI made no appealsand was medically separated. The assessment was “a mild Grade 1 tear, possibly Grade 2 at the very worst.” The examiner opined that the CI would benefit from use of a PCL stabilization brace.At the MEB exam on 21...

  • AF | PDBR | CY2012 | PD2012 00629

    Original file (PD2012 00629.rtf) Auto-classification: Denied

    The left knee PCL tear condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialtyor satisfy physical fitness standards.Hewas placed on limited duty andreferred for a Medical Evaluation Board (MEB).The MEB forwarded left knee PCL tear, surgically treated; left knee chondromalacia of the medial femoral condyle, surgically and medically treated; and left knee effusion, medically and surgically treated for Physical Evaluation Board...

  • AF | PDBR | CY2013 | PD 2013 01051

    Original file (PD 2013 01051.rtf) Auto-classification: Denied

    RECORD OF PROCEEDINGSPHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXXX CASE: PD-2013-01051 BRANCH OF SERVICE: Army BOARD DATE: 20140620 Left Knee Condition . RECOMMENDATION : The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

  • 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 | CY2012 | PD2012 01540

    Original file (PD2012 01540.rtf) Auto-classification: Denied

    The VA coded the left knee condition 5257, other impairment of the knee (subluxation or lateral instability) with a 10% rating and separately coded and rated limitation of motion and pain using code 5260, limitation of flexion at 10%. The mild varus instability noted on the C&P performed on 27 September 2006 was not noted on the MEB examination or on the second C&P examination, remote from separation. Physical Disability Board of Review

  • AF | PDBR | CY2013 | PD-2013-01937

    Original file (PD-2013-01937.rtf) Auto-classification: Denied

    The Board determined that the evidence reasonably supported pain limited motion for a disability rating of 10%; analogous to limitation of motion, coded 5299-5260.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 the right knee instabilityand 10% for the right knee limitation of motion for a combined 20% disability rating. BOARD FINDINGS : IAW DoDI 6040.44, provisions of DoD or Military...

  • 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 | CY2011 | PD2011-00657

    Original file (PD2011-00657.docx) Auto-classification: Denied

    The PEB adjudicated the left knee condition as unfitting, rated 20%, citing criteria of the Veterans Administration Schedule for Rating Disabilities (VASRD). ** Conceding §4.59 under joint code (as below) or ‘mild’ instability. Other PEB Conditions .

  • AF | PDBR | CY2012 | PD2012-01033

    Original file (PD2012-01033.pdf) Auto-classification: Denied

    Pre-Separation) – All Effective Date 20011208 Condition Code Rating Exam Left, knee arthroscopy; s/p PCL shrinkage 5299-5024 0% X 0 / Not Service-Connected x 0 0% 20011120 20011120 Combined: 0% physical therapy was recommended, however the CI continued to complain of pain and knee instability especially when running. The examiner considered the CI condition as a chronic posterior cruciate ligament deficiency of the left knee. Considering the 5257 code used by the PEB, the Boards noted the...