Search Decisions

Decision Text

AF | PDBR | CY2014 | PD 2014 00427
Original file (PD 2014 00427.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXX     CASE: PD-2014-00427
BRANCH OF SERVICE: NAVY  BOARD DATE: 20141113
SEPARATION DATE: 20050912


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty ET2/E-5 (41253/Electronics Technician) medically separated for right knee patellofemoral pain syndrome. The condition could not be adequately rehabilitated to meet the physical requirements of his Rating or satisfy physical fitness standards. He was placed on limited duty and referred for a Medical Evaluation Board (MEB). The right knee condition, characterized as “pain in joint multiple sites” and “unspecified disorder of lower leg joint,” was forwarded to the Physical Evaluation Board (PEB) IAW 1850.4E. The Informal PEB (IPEB) adjudicated “right knee patellofemoral pain syndrome, probable chondromalacia” as unfitting, rated at 10%. The IPEB added two Category III conditions (medial meniscal tear and small joint pains) as not separately unfitting and one Category IV condition (obesity) which did not constitute a physical disability. The CI made no appeals and was medically separated.


CI CONTENTION: “After discharge I continued to have problems with my R knee and was forced to have a 4th surgery at a civilian doctor. While he was able to finally repair the damage missed in 3 other Navy surgeries I continue to have according to doctors will always have, pain and problems with that knee. I believe that much of my now lifelong issues are based solely on the injury incurred during active duty service and the mistake and errors made by the doctors who performed my Navy surgeries. I do not believe it to be intentional, however, that doesn’t negate the fact that I will forever have to deal with my disability incurred on active duty.”


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 together below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board. The multiple site joint pain and obesity conditions, identified as not unfitting by the PEB, were not requested for review and thus are not within the defined scope. 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 (BCNR).


 RATING COMPARISON :

Service IPEB – Dated 20050526
 VA - (1 Mos. Pre -Separation)
Condition
 Code Rating Condition Code Rating Exam
Rt. Knee Patellofemoral Pain Syndrome 5299-5003 10% Patellofemoral Syndrome, Rt. Knee s/p Arthroscopy 5299-5003 10% 20050816
Other x3 (Not in Scope)
 Other x5
Rating: 10%
 Combined: 30%
Derived from VA Rating Decision (VA RD ) dated 200 51220 (most proximate to date of separation )


ANALYSIS SUMMARY: The Board acknowledges the CI’s opinion that a medical error contributed to his disability. It is noted for the record that the Board has no jurisdiction to investigate or render opinions in reference to such allegations; and, redress in excess of the Board’s scope of recommendations (as noted above) must be addressed by the BCNR and/or the United States judiciary system. Additionally, 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.

Right Knee Condition. The CI suffered a right knee injury while playing volleyball in November 1999. He continued to experience pain in spite of conservative treatment and a magnetic resonance imaging study in February 2000 revealed a right medical meniscus tear (MMT). He underwent surgical trephination (drilling of small holes in an attempt to restore blood supply to the torn meniscus for healing) in March 2000. Post-operative rehabilitation went well and in September 2000 he was returned to full activity to include fitness testing. He performed a fitness test in October 2000 and had 4 to 5 days of pain that resolved spontaneously. He then complained of increasing pain primarily with walking up stairs and was diagnosed with patellofemoral pain syndrome right knee. When those symptoms did not respond to treatment he underwent a diagnostic arthroscopy that was normal, the previous MMT had healed. Over the ensuing 3 years, although he was cleared for sea duty in June 2001, the CI’s right anterior knee pain continued with no locking and rare mention of swelling.

The narrative summary prepared 8 months prior to separation noted the CI had received two Limited Duty stints for right knee patellofemoral syndrome. He stated that his knee pain had markedly increased to 10/10 since he was placed on board his ship. This was mainly attributed to pre-deployment drills in which he had to run up and down stairs, as well as a short 6 day deployment resulting, again, in severe knee pain in which he stated that he was unable to walk. The physical exam findings are summarized in the chart below.

At the VA Compensation and Pension exam (performed a month prior to separation), the CI reported that his knee was associated with some pain on a constant basis. There was no physician-recommended incapacitation, functional impairment, or lost work time following recovery from the surgeries. The physical exam findings are summarized in the chart below. The examiner diagnosed patellofemoral syndrome.

The goniometric range-of-motion (ROM) evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Right Knee ROM (Degrees) PCC ~ 23 Mo. Pre-Sep NARSUM ~ 7.5 Mo. Pre-Sep VA C&P ~ 1 Mo. Pre-Sep
Flexion (140 Normal) 135 “Full ROM” 140
Extension (0 Normal) 0 0
Comment No effusion ; Stable knee; Pos. medial joint line tenderness Pos. c repitus & tenderness to palpation; N o effusion Pos. painful motion & crepitus; No Deluca criteria; Stable knee
§4.71a Rating 10 % * 10 % * 10%*
* IAW §4.59 Painful motion

The Board directed attention to its rating recommendation based on the above evidence. Both the PEB and VA applied the analogous Veterans Affairs Schedule for Rating Disabilities (VASRD) code of 5299-5003 (degenerative arthritis), and rated it 10% disabling. All data supports that the CI’s knee ROM were non-compensable and that there was satisfactory evidence of painful motion IAW VASRD§ 4.59. The Board reviewed the evidence for alternative coding/rating options and considered code 5258 (dislocated semilunar cartilage with frequent episodes of ‘‘locking,’’ pain, and effusion into the joint). The evidence does contain rare complaints of locking prior to surgical treatment of the MMT (none after) and rare complaints of swelling and only one episode of a “questionable” small effusion after his post-operative rehabilitation. Additionally, the CI underwent a diagnostic arthroscopy that documented that the MMT had healed. Board members agree that there was not adequate evidence to support utilization of the 5258 code. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt) and §4.59, the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right knee patellofemoral pain syndrome 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 patellofemoral pain syndrome 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 20131204, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record










                 
XXXXXXXXXXXXXX
President
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 8 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 USN
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USN


                                                      XXXXXXXXXXXXXX
                                            Assistant General Counsel
                  (Manpower & Reserve Affairs)

Similar Decisions

  • AF | PDBR | CY2012 | PD 2012 01635

    Original file (PD 2012 01635.rtf) Auto-classification: Denied

    After due deliberation in consideration of the preponderance of the evidence, the Board concluded there was insufficient cause to recommend a change in the PEB fitness determination for the any of the left knee conditions, so no additional disability ratings can be recommended.The Board next considered the CI’s right knee condition for its rating recommendation. BOARD FINDINGS : IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will...

  • AF | PDBR | CY2010 | PD2010-01153

    Original file (PD2010-01153.docx) Auto-classification: Denied

    I currently have to take pain medication often on a regular basis over the years for pain from my condition. Right Knee Condition . The Board notes that the MEB and initial VA C&P exams bracket the date of separation.

  • AF | PDBR | CY2011 | PD2011-01061

    Original file (PD2011-01061.docx) Auto-classification: Denied

    The FPEB convened 26 April 2007 and after reviewing newly provided medical documents, adjudicated the right knee chondromalacia osteoarthritis of the medial compartment as unfitting, rated 10% with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD). In January 2005 surgical arthroscopy was performed on the knee revealing right knee chondromalacia of the patella with lateral patellar mal-tracking and chondromalacia of the medial femoral condyle and lateral tibial...

  • 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 | CY2013 | PD 2013 00654

    Original file (PD 2013 00654.rtf) Auto-classification: Denied

    To date, both ankles continue to click and swell as well as both knees. Bilateral knee ROM was noted as approximately 0-130 degrees.At the VA Compensation and Pension examinationperformed 5 months after separation, the CI reported right greater than left knee pain and weakness. RECOMMENDATION : The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

  • AF | PDBR | CY2011 | PD2011-00913

    Original file (PD2011-00913.pdf) Auto-classification: Denied

    (2) is limited to those conditions which were determined by the PEB to be specifically unfitting for continued military service; or, when requested by the CI, those condition(s) “identified but not determined to be unfitting by the PEB.” The rating for unfitting conditions will be reviewed in all cases. The VA examiner reported right knee ROM as detailed above. 3 PD1100913 RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of the CI’s disability and...

  • 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 | CY2012 | PD2012-00198

    Original file (PD2012-00198.pdf) Auto-classification: Denied

    The Physical Evaluation Board (PEB) adjudicated the left knee PFPS conditions as unfitting, rated 10% with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD). Post-Sep Left Knee ROM Flexion (140 Normal) Extension (0 Normal) §4.71a Rating 10% 10% The CI was first evaluated in March 2000 for a 2-month history of knee pain while running following trauma. 3 PD12-00198 RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of the CI’s...

  • 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 | CY2012 | PD2012-00231

    Original file (PD2012-00231.docx) Auto-classification: Denied

    The PEB adjudicated the bilateral patella femoral syndrome condition as unfitting, rated 10%, with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD). Effective January 2005, the VA assigned separate ratings of 10% for each knee based on new examination evidence supporting separate ratings for each knee. The Board noted that PEBs often combine multiple conditions under a single rating when those conditions considered individually are not separately unfitting and...