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AF | PDBR | CY2014 | PD-2014-01123
Original file (PD-2014-01123.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2014-01123
BRANCH OF SERVICE: Army  BOARD DATE: 20141001
SEPARATION DATE: 20060708


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (25F/Network Switching Systems Operator) medically separated for a right knee condition. The right knee condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The right knee condition, characterized as “right knee pain and swelling secondary to a PVNS [pigmented villonodular synovitis]” by the MEB, was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded one other medically acceptable condition. The Informal PEB adjudicated “right knee pain…biopsy diagnosis of PVNS as unfitting, rated 0%,” with likely application of the VA 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: “Please consider all conditions.”


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 and contended and not unfitting headache are addressed below. No additional conditions are within the DoDI 6040.44 defined purview of the Board. 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 Military Records.


 RATING COMPARISON :

Service IPEB – Dated 20060531
 VA* - (4 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Right Knee Pain… 5099-5020 0% Pigmented Villonodular Synovitis, Right Knee 5257 0% 20061117
Headaches (Tension) Not Unfitting Migrainous Headaches 8100 30% 20061117
Other x 0
Other x 0 (Not in Scope)
Rating: 0%
 Combined: 30%
* Derived from VA Rating Decision (VA RD ) dated 200 61213 (most proximate to date of separation ( DOS ) )


ANALYSIS SUMMARY: The Board notes that the presence of a diagnosis, in and of itself, is not sufficient to render a condition unfitting and ratable. While the Disability Evaluation System (DES) considers all of the member's medical conditions, compensation can only be offered for those medical conditions that cut short the member’s career; and then only to the degree of severity present at the time of final disposition. However, the Department of Veterans Affairs, operating under a different set of laws (Title 38, United States Code), is empowered to periodically re-evaluate veterans for the purpose of adjusting the disability rating should the degree of impairment vary over time.

Right Knee Condition. During a deployment in January 2005, the CI experienced onset of right knee pain with swelling of uncertain etiology. X-rays and magnetic resonance imaging studies of the knee revealed no evidence of joint, ligament or bone disorder. After 34 months of conservative treatment, to include profiles for activity modification and physical therapy, the CI underwent arthroscopic surgical evaluation of the right knee in September 2005. Findings at surgery and biopsies taken were suggestive of an early form of PVNS, a benign, but progressive condition of the lining the knee joint.

At an orthopedic evaluation on 12 December 2005, the CI reported continued knee pain. On evaluation, range-of-motion (ROM) of the knee was full with diffuse pain. Injection of the knee with steroids resulted in a “100% relief of symptoms.” On follow-up orthopedic evaluation on 9 January 2006, the CI again reported knee pain. On examination of the knee, ROM was full with “nonspecific discomfort with motion.” Repeat steroid injection resulted in “near complete relief of pain.” On 8 February 2006, the CI again reported to the orthopedic clinic with knee pain. On evaluation “some tenderness was observed on ambulation of the knee with crutches.” On examination, ROM of the knee was full without pain, swelling, or spasm. Slight tenderness to palpation of the upper knee cap was noted. The examiner discussed a repeat arthroscopic evaluation to “reconfirm the diagnosis” with adjustment of therapy based on the result. This was not undertaken.

At the narrative summary (NARSUM) examination on 21 March 2006, 4 months prior to separation, the CI reported continued pain and swelling of the right knee with weight bearing and to require a crutch for ambulation. On examination flexion of the right knee was slightly reduced to 130 degrees with pain at extremes of flexion (normal: 140 degrees). Extension was normal. A range-of-motion (ROM) examination for the MEB, conducted on 22 March 2006 by physical therapy, documented the active goniometric ROM for the right knee to be normal and “was not limited by pain or mechanical condition.” The MEB history and physical recorded on the DD Form 2808 on 1 April 2006, recorded the lower extremity to be “normal.”

At the VA Compensation and Pension (C&P) evaluation on 17 November 2006, 5 months after separation, the CI reported slight knee pain which comes on only if “provoked” by ‘strenuous weight bearing, such as running, which he avoids’ and has no spontaneous “flare-ups”. By avoiding strenuous weight bearing “he is fine.” On examination, gait was normal without assistive devices. The knee ‘looked normal’ and had full ROM without pain, DeLuca findings, or laxity.

The Board directs attention to its rating recommendation based on the above evidence. The PEB rated the right knee pain condition 0% using codes 5099 musculo-skeletal disease, rated alternatively as 5020 synovitis (inflammation of the joint) citing knee pain and the use of crutches. The VA adjudicated a rating of 0% using code 5257, other impairment of the knee, noting full ROM of the knee without instability or pain on motion. The Board noted that the frequent reports of the CI in the record of painful swelling of the right knee and the need to use crutches to prevent said swelling. However, the objective evidence in record proximate to separation, documents ROM without pain, swelling or laxity of the right knee. The Board unanimously agreed that right knee condition did not rise to the level of 10% rating for painful motion, IAW §4.40 or §4.59 and recommends a rating of 0% IAW §4.71a and §4.31. The Board found no other appropriate codes for consideration.

Contended Headache Condition. The Board’s main charge with respect to the contended headache condition is an assessment of the fairness of the determination that it was not unfitting. The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard. The CI was involved in an explosion near his vehicle 5 May 2004. He was diagnosed with ringing in his ears in the absence of loss of consciousness or other injury. On 9 August 2004 he started having headaches twice per day and was diagnosed with post-concussive headache by the aid station duty medic. On clinic visit on 13 June 2005, headaches were reported to “respond quickly to medication.” The NARSUM physician on 21 March 2006 noted that the “member has a headache severe in type only once per week. This does not disturb his duty performance. The service member has no lost duty time secondary to these headaches. They are, therefore, not considered incapacitating . ” The VA C&P examiner on 17 November 2006 , reported the headache condition to be “ completely prevented with medication ” and the regimen “ continues to be effective . ” No profiles within one year of separation listing the headache condition were found on review of the service treatment record to include the final profile. The commander’s comments did not include the chronic headaches as a condition having impact on the unit’s mission requirements. There was no indication from the record that this condition significantly interfered with satisfactory duty performance. After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended chronic headache condition therefore, no additional disability rating is recommended.


BOARD FINDINGS: 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 pain condition, the Board unanimously recommends a disability rating of 0%, coded 5099-5020 IAW VASRD §4.71a and §4.31. In the matter of the contended headache condition, the Board unanimously recommends no change from the PEB determination as not unfitting. 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 20140529, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record






XXXXXXXXXXXXXXX
President
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, AR20150006242 (PD201401123)


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 and hereby deny the individual’s application. This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

BY ORDER OF THE SECRETARY OF THE ARMY:




Encl                       XXXXXXXXXXXXXXX
                           Deputy Assistant Secretary of the Army
                           (Review Boards)
                                                     
CF:
( ) DoD PDBR
( ) DVA

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