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AF | PDBR | CY2014 | PD-2014-01090
Original file (PD-2014-01090.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX        C ASE: PD -2014 -01090               
BRANCH OF SERVICE: AIR FORCE      BOARD DATE: 201 5 0715
Separation Date: 20091211


SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (C I) was an activated Reserve E-2 ( Health Service Management Specialist ) medically separated for bilateral knee. The condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty (AFS). She was issued a temporary profile and referred for a Medical Evaluation Board (MEB). The “bilateral tibial plateau stress fractures” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123. No other condition was submitted by the MEB. The Informal PEB (IPEB) adjudicated “bilateral medial tibial stress fracture” as unfitting, rated 20%, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION : “Her condition continues to worsen and negatively impact her daily activities. Her complete submission is at Exhibit A.”


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 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 :

IPEB – Dated 20091029
 VA* - (~6 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Bilateral Medial Tibial Stress Fracture: Right/Left 5299-5262 20% Patellofemoral Syndrome, Right Knee 5260 10% 20100601
Stress Fracture, Left Tibia-Fibula 5262 0%
Stress Fracture, Right Tibia-Fibula 5262 0%
Left Knee Condition 5260 NSC
Other x 0
Other x 1
RATING: 20%
 RATING: 10%
*Derived from VA Rating Decision (VARD) dated 20100618 (most proximate to date of separation (DOS) ) .



ANALYSIS SUMMARY : Left and Right Medial Tibial Stress Fracture Condition . The CI developed bilateral knee pain during her second week of Basic Training in April 2009. Bilateral knee X -rays were negative. Physical training (PT) was initiated on 23 April 2009 because the CI continued to report bilateral knee pain after walking or standing for more than 10 minutes. The examiner documented tenderness at the medial tibial plateau bilaterally. A b one s can demonstrated moderate to severe bilateral medial tibial plateau stress fractures and mild stress changes bilateral femoral condyles in the ankles and feet. The CI underwent extensive PT from 15 June 2009 through to 28 August 2009 with poor results. The bilateral knee X - ray was normal. The Orthopedist noted bilateral knee findings of positive patellar grind, range - of - motion (ROM) to 130 degrees , and tenderness to palpation under the medial tibial facet and medial femoral condyles .

The MEB Narrative Summary (NARSUM) exam approximately 3 months prior to separation documented that despite 100 days of rehabilitation and rest, the CI continued to report 2/10 pain at rest which increased activity. The physical exam demonstrated normal lower ext remity strength, normal reflexes, ROM’s right knee flexion 120 degrees (140 normal), left knee flexion 125 degrees , and extension 0 degrees bilaterally. The examiner noted that knee flexion, bilaterally, was limited by pain. The VA Compensation and Pension (C&P) exam approximately 5 months after separation documented that the CI had intermittent bilateral knee pain, weakness, stiffness, instability, locking and lack of endurance. She wore an elastic knee brace for her right knee. There were physical exam findings of bilateral positive tenderness to palpation on the medial low right patella, full ROM flexion , discomfort on full extension on the right knee , and Deluca was positive for discomfort only .

The Board direct ed attention to its rating recommendation based on the above evidence. The Board coded the b ilateral m edial t ibial s tress f racture: r ight and l eft condition as 5299 analogous to 5262 ( Tibia and fibula, impairment of ) and rated at 20 % for moderate knee disability (10% for each knee including bilateral factor) . The VA coded the s tress f racture, l eft t ibia- f ibula condition rated at 0% , coded 5262 and the s tress f racture, r ight t ibia- f ibula condition rated at 0% , coded as 5262 . The Board considered whether the evidence supported a higher than 20% rating. There was no clear evidence that one lower extremity was significantly worse that the other. All evidence proximate to separation documented chronic tenderness in the medial tibial plateau bilaterally. A b one s can demonstrated moderate to severe bilateral medial tibial plateau stress fractures . The Board determined that neither the left nor the right knee disability rose to the level of marked for a higher rating. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the b ilateral m edial t ibial s tress f racture: r ight and l eft 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 bilateral medial tibial stress fracture: right and left 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 recharacterization of the CI’s disability and separation determination .

The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20 140226 , w/atchs
Exhib it B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record







XXXXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review
invalid font number 31502


SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

Dear XXXXXXXXXXXXXXXXXXXX :

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-01090 .

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate. Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board. I concur with that finding and their conclusion that re-characterization of your separation is not warranted. Accordingly, I accept their recommendation that your application be denied.


Sincerely,







XXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
 Record of Proceedings invalid font number 31502

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