Search Decisions

Decision Text

AF | PDBR | CY2014 | PD-2014-00097
Original file (PD-2014-00097.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2014-00097
BRANCH OF SERVICE: Army  BOARD DATE: 20150130
SEPARATION DATE: 20060428


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Unit Supply Specialist) medically separated for bilateral knee pain. The condition 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). “Status post left anterior cruciate ligament (ACL) reconstruction in April 2005 and arthroscopic debridement in October 2005 with continued left knee pain” and “partial anterior cruciate ligament (ACL) tear right knee with continued right knee pain” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded one other condition (low back pain) for PEB adjudication. The Informal PEB adjudicated “chronic left knee pain with some loss of joint motion” and “chronic pain right knee” as unfitting, rated 10% and 0% respectfully, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The remaining condition was determined to be not unfitting . The CI made no appeals and was medically separated.


CI CONTENTION: “MEMBER mobility of Legs WERE Limited due to injuries, changed type of work field member could apply for after discharge. Service member was young age when injured, which affected her career growth in a physical job. Injuries limited mobility in daily activities due to inflammation, flexion + extension issues.”


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 20060414
 VA* (~2 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Left Knee Pain 5099-5003 10% Left Anterior Cruciate Ligament and Medial Meniscus Tears 5003-5261 10% 20060626
Chronic Pain Right Knee 5099-5003 0% Partial Right Anterior Cruciate Ligament Tear 5257 10% 20060626
Other x1 (Not In Scope)
 Other x 6
RATING: 10%
 RATING: 20%
* Derived from VA Rating Decision (VA RD ) dated 200 60808 (most proximate to date of separation ( DOS ) )


ANALYSIS SUMMARY:

Left knee. The CI injured her left knee during a physical fitness event in February 2005. The initial plain film X-rays were normal; however, a magnetic resonance imaging (MRI) study revealed a torn ACL. She underwent arthroscopic repair in April 2005 with post-operative physical therapy (PT). Her had continued pain and restricted range-of-motion (ROM) and had a second arthroscopic procedure to remove adhesions in October 2005. The orthopedic addendum prepared 4 months prior to separation noted the CI underwent intensive PT, regained much of her motion, and was doing fairly well with the left knee at that time. The physical exam findings are summarized in the chart below. The narrative summary (NARSUM) prepared a month prior to separation noted that the CI reported her left knee extension improved, and she felt that she was progressing pretty well until she suffered an injury to her right knee in November 2005. She noted some degree of left knee swelling in response to increased activity with no noticeable instability. The NARSUM examiner referred to the detailed orthopedic exam contained in the orthopedic addendum. Three months prior to separation the CI had ROM measurements performed by PT which are summarized below. The VA Compensation and Pension (C&P) exam performed 2 months after separation was missing from the evidence present for review; however, the pertinent physical exam findings were documented in the VARD which is present for review and are summarized in the chart below.

The goniometric 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.

Left Knee ROM (Degrees) Ortho Addendum 4 Mo. Pre-Sep PT 3 Mo. Pre-Sep VA C&P ~2 Mo. Post-Sep
Flexion (140 Normal) 135 112 140
Extension (0 Normal) 3 0 5
Comment Normal gait; Decreased quad strength - No instability; Pos. Deluca criteria
§4.71a Rating 10% (PEB 10%) 10%* 10% (VA 10%)
*IAW VASRD §4.40, Functional loss

The Board directed its attention to its rating recommendation based on the above evidence. The PEB adjudicated the left knee pain condition by applying the analogous VASRD code 5099-5003, degenerative arthritis, and rated it 10% citing “some loss of joint motion.” The VA applied a combination code of 5003-5261 (limitation of leg extension) and also rated it 10%. The Board noted that a limitation of 10 degrees extension is required for the 10% rating under code 5261 which was not present in this case (a limitation of 5 degrees extension was documented in the C&P exam). All exams proximate to separation document non-compensable ROM measurements and there was no post-surgical impairment that would allow for the application of any knee specific VASRD code. The service treatment record evidence does support the presence of limited motion caused by swelling that was responsible for some functional loss. Analogous coding is required as the left knee MRI did not demonstrate any degenerative changes. There is no evidence supported route to a rating higher than 10% in this case. Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 10% for the left ACL and medial meniscus tear condition was appropriately recommended in this case.

Right knee. The orthopedic addendum prepared 4 months prior to separation noted that since the left knee surgery in October, the CI had an episode where she twisted her right knee in late November and had swelling and a large amount of pain. She underwent an MRl on 29 November 2005·which revealed what appeared to be a partial ACL tear and possible meniscus tear. Since then, she had continued rehabilitation. She was able to use the right knee and progressed with ROM and strength, but had episodes of feeling like the knee gave out. She did not wish to undergo any surgery for the right knee, and wished to treat it conservatively. The physical exam findings are summarized below. The NARSUM prepared a month prior to separation noted that her right knee stayed swollen and she did note some subjective right knee instability with no definite locking. The NARSUM examiner referred to the detailed orthopedic exam contained in the orthopedic addendum. Three months prior to separation the CI had ROM measurements performed by PT which are summarized below. The C&P exam performed 2 months after separation was missing from the evidence present for review; however, the pertinent physical exam findings were documented in the VASRD which is present for review and are summarized in the chart below.

The goniometric 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) Ortho Addendum 4 Mo. Pre-Sep PT 3 Mo s . Pre-Sep VA C&P ~2 Mo. Post-Sep
Flexion (140 Normal) 130 122 140
Extension (0 Normal) 0 0 0
Comment Normal gait; Minimal effusion; Mild instability; Decreased quad strength - No instability; No Deluca criteria
§4.71a Rating 10% (PEB 0%) 10%* 10%* (VA 10%)
*IAW VASRD §4.40, Functional loss

The Board directed its attention to its rating recommendation based on the above evidence. The PEB adjudicated the left knee pain condition by applying the analogous VASRD code 5099-5003 (degenerative arthritis) and rated it 0% citing “Rated as analogous to degenerative arthritis without loss of joint motion.” The VA applied code 5257 (other impairment of the knee recurrent subluxation or lateral instability) and rated it 10% consistent with “slight.” All exams document non-compensable ROM measurements. The evidence supports that the CI had at least a partial right ACL tear and did not undergo and surgical correction. She experienced subjective instability and the orthopedic specialist’s examination documented “mild instability.” Rating using code 5257 requires application of the subjective criteria of slight, moderate, or severe for the 10%, 20%, or 30% rating respectively. In keeping with the subjective instability the CI experienced and the “mild instability” documented by the orthopedic specialist, Board members agree that the CI’s right knee instability was best described as “slight.” After due deliberation, considering all of the evidence and mindful of VASRD §4.3, the Board recommends a disability rating of 10% for the partial right ACL tear 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 left ACL and medial meniscus tear condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. In the matter of the partial right ACL tear condition, the Board unanimously recommends a disability rating of 10%, coded 5257 IAW VASRD §4.71a. 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 her prior medical separation:

CONDITION VASRD CODE RATING
Left Anterior Cruciate Ligament and Medial Meniscus Tears 5299- 5003 10%
Partial Right Anterior Cruciate Ligament Tear 5257 10%
COMBINED 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20140122, 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, AR20150008496 (PD201400097)


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 20% 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 | CY2014 | PD-2014-00930

    Original file (PD-2014-00930.rtf) Auto-classification: Denied

    Post-Separation)ConditionCodeRatingConditionCodeRatingExam Chronic Left Knee Pain, Patellofemoral Syndrome, s/p Arthroscopy x25099-500310%Degenerative Arthritis, Left Knee5260-500310%20110803 Internal Derangement, Left Knee5003-525730%20110803Other x0Other x1 RATING: 10%RATING: 40%*Derived from VA Rating Decision (VARD)dated 20120720(most proximate to date of separation [DOS]) Left Knee Pain . After review by a Decision Review Officer, the VA applied two different VASRD codes to the left...

  • 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 | CY2011 | PD2011-00832

    Original file (PD2011-00832.docx) Auto-classification: Denied

    The FPEB and VA each coded the individual knees at 10% using the criteria for arthritis (5003), with the VA indicating a traumatic onset by using code 5010. Left Knee : With regards to the left knee, the Board considered that the preponderance of the record supported the 10% rating for the left knee for limited motion. RECOMMENDATION : The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows:

  • AF | PDBR | CY2009 | PD2009-00583

    Original file (PD2009-00583.docx) Auto-classification: Denied

    The MEB found in view of the “osteoarthritis degeneration of the left knee joint” as interfering with duty and forwarded “Bicompartmental Osteoarthritis of the Left Knee, Failed ACL (Anterior Cruciate Ligament) Reconstruction in the Left Knee and Accompanying Anterolateral Rotatory Instability” to the Physical Evaluation Board (PEB) on the NAVMED 6100/1. Based on the examination results, the examiner opined that the CI had Bicompartmental osteoarthritis of the left knee secondary to the ACL...

  • AF | PDBR | CY2014 | PD-2014-00135

    Original file (PD-2014-00135.rtf) Auto-classification: Approved

    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 Military Records. Post-Separation)ConditionCodeRatingConditionCodeRatingExam Chronic Pain/Instability Left Knee5099-500310%Left Knee Multi-Ligament Injury5010-525710%20070331Other x 0 (Not in Scope)Other x 0 (Not in Scope)20070331 Combined: 10%Combined: 10% *Derived from VA Rating Decision (VARD)...

  • 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 | PD2009-00514

    Original file (PD2009-00514.docx) Auto-classification: Denied

    Approximately one month after the CI separated from service he had surgery (20050518) to correct his ACL tear and lateral meniscus tear in his right knee. No evidence this condition was unfitting at the time of separation from service. After careful consideration of all available records the Board unanimously determined that the CI’s right knee condition is most appropriately rated at a combined 20% with 10% for 5259 Right Knee Medial and Lateral Meniscal Tear, s/p Repair of Medial...

  • 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 | CY2010 | PD2010-00025

    Original file (PD2010-00025.docx) Auto-classification: Denied

    Orthopedic exam several weeks later noted a 1+ effusion with a 1+ Lachman test (i.e., positive anterior instability). After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board unanimously recommends a separation rating of 10% for the left knee ACL condition coded 5257 and 10% for the medial meniscus condition coded 5259 for a combined rating of 20%. Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

  • AF | PDBR | CY2010 | PD2010-00014

    Original file (PD2010-00014.docx) Auto-classification: Denied

    The Informal PEB adjudicated the left knee ACL deficiency condition as unfitting, rated 20%, with application of SECNAVINST 1850.4E, DoDI 1332.39 and Veterans Administration Schedule for Rating Disabilities (VASRD), respectively. Left Knee Condition . Exhibit C. Department of Veterans' Affairs Treatment Record.