Search Decisions

Decision Text

AF | PDBR | CY2014 | PD-2014-00093
Original file (PD-2014-00093.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2014-00093
BRANCH OF SERVICE: Army  BOARD DATE: 20141216
SEPARATION DATE: 20080122


SUMMARY OF CASE: The evidence of record indicates this covered individual (CI) was an active duty E-3 (Operating Room Specialist) medically separated for a right knee condition. This condition could not be adequately rehabilitated to meet the requirements of her Military Occupational Specialty or physical fitness standards. The CI was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The knee condition, characterized as “chondromalacia right knee” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501; no other conditions were submitted by the MEB. The PEB adjudicated “chondromalacia patella, right knee …” as unfitting, rated 0%, referencing AR 635-40, appendix B-15 and the “table of analogous codes . ” The CI made no appeals and was medically separated.


CI CONTENTION: “I can barely walk most days from knee pain, which also interferes with sleep & work. I live with constant 8 on a 1-10 pain scale.”


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 Veterans Affairs Schedule for Rating Disabilities (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 :

Service IPEB – Dated 20071128
 VA - (7 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chondromalacia Patella, Right Knee Evaluated as Arthritis … 5099-5003 0% Degenerative Joint Disease, Right Knee 5003-5260 10% 20080814
Residual Scar, S/P Right Knee … 7804 10% 20080814
No Additional MEB/PEB Entries in Scope
 No Additional VA Entries in Scope
Combined: 0%
 Combined: 40%
Derived from VA Rating Decision (VA RD ) dated 200 80905 .



ANALYSIS SUMMARY :

Right Knee Condition. The narrative summary and the service treatment record detailed that the CI had two surgeries on the right knee (for partial tear of the anterior cruciate ligament, medial meniscus tear, chondral [cartilage] tearing of the medial femoral condyle [lateral surface of the knee] and plica debridement) prior to entering service and required a waiver to enlist. She reinjured the knee in January 2006 (twisting knee on a road march) and subsequently had increased pain and swelling with running – she had noted that “her knee has ‘locked up’ or buckled on several occasions” since entry. She underwent surgical realignment of her patella (with medial menisectomy) in April 2007 (9 months prior to separation). The MEB exam 5 months prior to separation noted a healed surgical scar, palpable hardware at the tibia, edema (swelling) generally around the patella, tenderness with palpation, and crepitus (grating) with motion. No ranges-of-motion (ROMs) were done.

The orthopedic consult 3 months prior to separation (“MEB Consultation”) noted that the CI had no episodes of recurrent instability after her surgery, that she had persistent pain and recurrent effusions in her knee, and that she was unable to return to full duty. Exam demonstrated a well-healed surgical scar on the knee, positive apprehension and inhibition of her patella, tenderness to palpation over the palpable retained hardware and the lateral aspect of the patellofemoral joint, hypermobility of her patellofemoral joint and trace effusion. The ROM of the right knee was 0 to 130 degrees (normal 0 to 140 degrees). She had slight decreased strength (4+/5) with extension of the right knee, some grinding and crepitus of the patellofemoral joint (between the kneecap and the leg), and no evidence of laxity. The final diagnosis was chondromalacia (softening of the cartilage) of the right knee.

Subsequently, 2 months prior to separation (on the day of the MEB), the CI had a surgery to remove the hardware from her original procedure and 2 weeks after that her sutures were removed. The CI reported that she had “full ROM,” and the orthopedist noted that she was neurovascularly intact with full ROM.

At t he VA Compensation and Pension exam 7 months after separation , the CI complained of stiffness of the right knee, “painful numbness” lateral and distal to the knee (so bad that she could not touch it at times), tenderness directly on the patella and increasing pain that sho t / radiated down her leg if she stood too long . The examiner stated, “She has had no further dislocation of her right knee.” On exam, the CI was able to extend her knee to 0 degrees (normal) 3 times, but was able to flex her knee only once, to 120 degrees (normal 140 degrees ), due to pain. The CI reported extreme allodynia ( pain due to a stimulus which does not normally provoke pain ) with any type of touch to her right knee. The examiner stated, “ In regards to the Deluca requirements, there is an additional estimated loss of 20 degrees of flexion of the right knee due to flare-up secondary to pain ….”

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the right knee condition at 0% with code 5099-5003 (Arthritis, degenerative), citing no loss of mechanical motion. The VA rated the condition at 10% analogous to code 5260 (“limitation of flexion of knee”), based on pain-limited motion.

Most exams proximate to separation (and all exams with formal ROM testing) indicated painful or limited motion of the right knee, and the knee was symptomatic. Given the CI’s degenerative changes and meniscal surgeries, the Board considered the criteria for 5258 (20% - Cartilage, semilunar, dislocated, with frequent episodes of “locking,” pain and effusion into the joint) and 5259 (10% - Cartilage, semilunar, removal of, symptomatic). There was insufficient evidence of frequent effusions, or locking following surgical repair which would support rating under code 5258. There was no post-surgical instability for dual rating. Meniscal rating at 10% analogous to code 5259 includes painful motion and there was no ROM limitation that would warrant higher than a 10% rating.

Any contribution of the scar for decreased motion relating to the knee was considered under the rating of the knee. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10%, coded 5003-5259 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 AR 635-40 as well as the Table of Analogous Codes for rating the knee condition was operant in this case and the condition was adjudicated independently of these regulations by the Board. In the matter of the right knee condition, the Board unanimously recommends a disability rating of 10%, coded 5003-5259 IAW VASRD §4.71a. There were no other conditions within the Board’s scope of review for consideration.


RECOMMENDATION: The Board recommends modifying the case determination as follows, effective the date of medical separation:

UNFITTING CONDITION VASRD CODE RATING
Chondromalacia Patella, Right Knee 5003-5259 10%
COMBINED 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131223, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record






                                   
XXXXXXXXXXXXXXX
President
DoD 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 XXXXXXXXXXXXXXX, AR20150008495 (PD201400093)


1. 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 to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation. This decision is final.

2. I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.

3. I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:




Encl              XXXXXXXXXXXXXXX
                           Deputy Assistant Secretary of the Army
                           (Review Boards)

CF:
( ) DoD PDBR
( ) DVA

Similar Decisions

  • 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-2014-00563

    Original file (PD-2014-00563.rtf) Auto-classification: Approved

    Post-Separation) ConditionCodeRatingConditionCodeRatingExam Low Back Pain5299-523710%Chronic Low Back Strain523710%20050706Left knee Pain5099-50030%Residuals L/Knee Lateral Meniscus Repair, Chondromalacia Patella5259-501410%20050706Other x 0 (In Scope)Other x 1 Combined: 10%Combined: 20%Derived from VA Rating Decision (VARD)dated 20050811 ( most proximate to date of separation) Low Back Pain Condition . The CI complained of dull constant pain in the left joint line and pain behind the...

  • AF | PDBR | CY2013 | PD-2013-01390

    Original file (PD-2013-01390.rtf) Auto-classification: Approved

    Left Knee Condition . The range-of-motion (ROM) was flexion to 140 degrees (normal).There is one physical therapy note in the STR from September 2004 (after the NARSUM, 5 weeks prior to separation) which states “popping gone/clunking gone” (indicating pre-operative signs of loose cartilage had resolved); it also documents a normal gait with “mild” tenderness as the only positive finding, with nodocumentation of effusion, cartilage signs or instability.The VA Compensation and...

  • AF | PDBR | CY2012 | PD2012-00891

    Original file (PD2012-00891.pdf) Auto-classification: Approved

    RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW Rating 10%* 10% Exam 20000325 20000325 BRANCH OF SERVICE: ARMY SEPARATION DATE: 20040302 NAME: XXXXXXXXXXXXXXX CASE NUMBER: PD1200891 BOARD DATE: 20130125 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC E-4 (62E/Heavy Construction Equipment Operator), medically separated for right knee injury. There was no MEB ROM evaluation. Meniscal coding...

  • AF | PDBR | CY2009 | PD2009-00660

    Original file (PD2009-00660.docx) Auto-classification: Denied

    In spite of nonsteroidal anti-inflammatory medications, physical therapy, and steroid injections, the CI had continuous periods of limited duty (LIMDU), and was then referred to the Medical Evaluation Board (MEB). Painful right knee; and 3. Knee Medial Meniscus Tear and Patellofemoral Plica Syndrome525710%20080915Painful R. Knee-S/P Surgical Repair of R. Knee Medial Meniscal Tear-↓No Additional MEB Entries↓Irritable Bowel Syndrome731930%20080915Sternal Pain s/p Fx...

  • AF | PDBR | CY2012 | PD2012 01094

    Original file (PD2012 01094.rtf) Auto-classification: Approved

    The PEB adjudicated the right knee condition (specifying surgical residuals)as unfitting,rated 0%, citing criteria of the Veterans Affairs Schedule for Rating Disabilities (VASRD) and with possible application of the US Army Physical Disability Agency (USAPDA) pain policy.The CI made no appeals and was medically separated. The NARSUM stated, “He has not had any significant relief of his pain to this time. The VA Compensation and Pension exam,7 months after separation, recorded “constant...

  • AF | PDBR | CY2013 | PD 2013 01065

    Original file (PD 2013 01065.rtf) Auto-classification: Approved

    RATING COMPARISON : Service IPEB – Dated 20040505VA - (~ 4.5 Mos Pre-Separation)ConditionCodeRatingConditionCodeRatingExam Chronic Bilateral Knee Pain5099-500310%Degenerative Joint Disease Left Knee501010%20040415Degenerative Joint Disease Right Knee501010%20040415Residual Scarring Left Knee Surgeries780410%20040415No Additional MEB/PEB EntriesOther x 520040415 Combined: 10%Combined: 80% *Derived from VA Rating Decision (VARD) dated 20040910 (most proximate to date of separation (DOS))...

  • AF | PDBR | CY2013 | PD-2013-00776

    Original file (PD-2013-00776.rtf) Auto-classification: Approved

    The NARSUM conducted on 13 June 2007 (2 months prior to separation)documented constant pain rated 4/10 on average, exacerbated by “any increased activity, especially prolonged standing or walking up or down stairs.” The examiner further stated, “He denies any significant swelling of the knee, but states that it does lock up at least once or twice per day, with frequent popping.” Physical findings for the knee were not documented in the NARSUM, but measured ROM was flexion 128 degrees (normal...

  • AF | PDBR | CY2014 | PD-2014-00375

    Original file (PD-2014-00375.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. RATING COMPARISON : Service IPEB – Dated 20061023VA -(9 Months Pre-Separation)ConditionCodeRatingConditionCodeRatingExam Grade III/IV Chondromalacia, Left Knee5099-50030%Left Knee Chondromalacia of the...

  • AF | PDBR | CY2011 | PD2011-00803

    Original file (PD2011-00803.docx) Auto-classification: Denied

    SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (0311 / rifleman), medically separated for a left knee condition. The PEB adjudicated the left knee with limited range-of-motion (ROM) condition as unfitting rated 10%; additionally grade II chondromalacia condition rated category II; and hypertension condition rated category III with application of SECNAVINST 1850.4E and Veterans Administration...