Upgrade.Vet

AF | PDBR | CY2014 | PD-2014-01877

Original file (PD-2014-01877.rtf) Auto-classification: Approved

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX C ASE: PD -20 1 4 - 0 1877
BRANCH OF SERVICE: Army BOARD DATE: 201 5 1030

Separation Date: 20060317

SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Petroleum Supply Specialist) medically separated for bilateral knee pain. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The bilateral knee pain condition, characterized as “bilateral knee pain” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The Informal PEB adjudicated “bilateral knee pain” as unfitting, rated 0%, with likely application of the US Army Physical Disability Agency (USAPDA) pain policy. The CI made no appeals and was medically separated.

CI CONTENTION : “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 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 20060317	VA (NO SHOW)
Condition	Code	Rating	Condition	Code	Rating	Exam
Bilateral Knee Pain	5099-5003	0%	Arthritis, Left Knee w/Tendon Rupture (claimed as bilateral knee injury)	5110-5260	0%*	No Show
			Arthritis, Right Knee (claimed as bilateral knee injury)	5110-5260	0%*	No Show
Other x0	Other x1
Combined: 0%	Combined: 10%

Derived from VA Rating Decision (VARD) dated 20090521 (most proximate to date of separation [DOS]) pending VA exam

ANALYSIS SUMMARY : I

Bilateral Knee Pain Condition . The PEB rated the bilateral knee pain the single analogous code 5099-5022 ( Periostitis ) . The Board, IAW VASRD §4.7 (higher of two evaluations) and DoDI 6040.44 , must consider separate ratings for PEB bilateral joint adjudications; although, separate fitness assessments must justify each disability rating. In this case, the knees were considered to fail retention standards; both were implicated by the narrative summary ( NARSUM ) ; and in the commander’s statement no specific knee was mentioned; both knees were profiled (bilateral anterior knee pain) . Members agreed therefore that each knee should be conceded as separately unfitting; and, that coding and rating features were logically identical.

The CI injured his left knee on 5 January 2005 when he stepped into a dip in the road and felt his left knee buckle , which caused a sharp pain. The Orthopedist evaluated the CI’s left knee and ordered physical therapy (PT) , a non-steroidal anti-inflammatory drug (NSAID) and exercises. An X -ray of the left knee showed a chronic avulsed enthesophyte (boney projection that attaches to a tendon or ligament) of the quadriceps insertion at the patella. The right knee X -ray revealed an insertional enthesophyte at the attachment of the quadriceps tendon on the patella. The CI underwent left knee debridement with removal of the enthesophyte on 22 March 2005. The Orthopedist noted that the CI reported some right knee pain in addition to the left knee post-operative pain. The primary care provider also documented the CI report of chronic left knee pain and more problems with his right knee. The physical exam findings were normal range-of-motion ( ROM ) and tenderness to palpation at the insertion of the patellar tendon on each knee and minimal pain relief with NSAID use . Four months later, t he Orthopedist documented continued bilateral constant, sharp knee pain with painful motion of the left knee and right knee pain on stress testing. The MEB NARSUM exam approximately 3 months prior to separation documented bilateral knee pain. The MEB NARSUM physical exam findings are summarized in the chart below. The CI failed to show for the scheduled VA Compensation and Pension (C&P) exam. The C&P exam 3 years after separation did not focus on the bilateral knee condition , but rather on the spine condition. Although the exam focused on the spine, the examiner documented normal gait, patellar reflexes, and leg strength.

The 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.

Knee ROM (Degrees)	MEB 3.5Mo. Pre-Sep	PT 1. 5 Mo. Pre-Sep
	Left	Right	Left	Right
Flexion (140 Normal)	Referenced ROM work sheet- missing from STR	131	133
Extension (0 Normal)		0	0
Comment	Normal gait; Pos. tenderness to palpation & painful motion; No swelling; No instability; Normal strength	Pos. painful motion bilaterally
§4.71a Rating	10%*	10%*	10%*	10%*
	10% (PEB 0%)

invalid font number 31502 *IAW VASRD §4.59 Painful motion invalid font number 31502
invalid font number 31502

The Board direct ed attenti on to its rating recommendation based on the above evidence . The PEB coded the bilateral knee pain condition as 5099 analogous to 5003 and rated at 0% with application of the USAPDA pain policy. The VA applied the combination code 5110 ( loss of use of both feet ) with 5260 (limitation of leg flexion) to each knee and separately rated each knee at 0% due to the CI’s “no show” for his physical exam. The 9 July 2014 VARD increased the right and left knee ratings to 10% each knee effective on 9 October 2013 based on functional loss due to painful motion. There was only one exam with ROM measurements available fo r review, the PT exam performed a month prior to separation , which was assigned the greatest probative value by the Board . That exam documented non-compensable ROM measurements for each knee which was also consistent with the data contained in the service treatment records (STR) . That PT exam also documented painful motion of each knee and review of the STR did not result in identification of any other finding that would allow for application of any knee specific VASRD code. The PT exam met the 10% criteria rating for both the right and left knee s with application of VASRD §4.40 Functional loss and §4.59 painful motion. After due deliberation in consideration of the totality of the evidence, the Board concluded that the right and left knee pain were each reasonably justified as separately unfitting. Considering all of the evidence and mindful of VASRD §4.3 ( Reasonable doubt ) , the Board recommends a disability rating of 10% coded 5099-5003 IAW VASRD §4.71a for the right knee pain and 10% coded 500 9-5 003 IAW VASRD §4.71a for the left knee pain .

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 the USAPDA pain policy for rating bilateral knee pain was operant in this case and the condition was adjudicated independently of that policy by the Board. In the matter of the bilateral knee pain condition , the Board unanimously recommends that each joint be separately adjudicated as follows: an unfitting right knee pain condition coded 5099-5003 and rated 10%, and an unfitting left knee pain condition, coded 5099-5003 and rated 10%, both 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 his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING
Right Knee Pain	5099-5003	1 0%
Left Knee Pain	5099-5003	10%
COMBINED (w/ BLF)	2 0%

invalid font number 31502

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20 140417 , w/atchs
Exhib it 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 , AR20150009955 (PD201401877)

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 | CY2013 | PD-2013-02688

Original file (PD-2013-02688.rtf) Auto-classification: Approved

The Informal PEB (IPEB)adjudicated the chronic bilateral knee pain as unfitting, rated 10%, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). 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. invalid font number 31502 BOARD FINDINGS : IAW DoDI 6040.44, provisions of DoD or Military...
AF | PDBR | CY2014 | PD-2014-00894

Original file (PD-2014-00894.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 VASRD standards to the unfitting medical condition at the time of separation. There was no right knee instability noted at the MEB exam. In the matter of the bilateral knee pain condition, the Board unanimously recommends that each joint be separately adjudicated as follows: an unfitting right knee pain condition coded 5003 and rated 10%, and an...
AF | PDBR | CY2012 | PD2012 01789

Original file (PD2012 01789.rtf) Auto-classification: Approved

The PEB adjudicated “chronic bilateral knee pain secondary to bilateral patella-femoral arthrosis, s/p bilateral lateral retinacular release”as unfitting, rated 0% with application of the VA Schedule for Rating Disabilities (VASRD).The sixremaining conditions were determined to be not unfitting. Pre-SepLeftRightLeftRightFlexion (140 Normal)140135> 105>105Extension (0 Normal)00CommentStable kneeStable kneePainful motion noted at MEB§4.71a Rating10%10%10%10%*The MEB ROM numbers are from the...
AF | PDBR | CY2014 | PD-2014-00701

Original file (PD-2014-00701.rtf) Auto-classification: Approved

Pre-Separation)ConditionCodeRatingConditionCodeRatingExam Chronic Bilateral Knee Pain due to RPS5009-50030%RPS Right Knee526010%20030403RPS Left Knee526010%20030403Other x0Other x920030403 Combined: 0%Combined: 60%Derived from VA Rating Decision (VARD)dated 20030725(most proximate to date of separation [DOS]) ANALYSIS SUMMARY :The PEB combined the right and left knee conditions under a single Service disability rating, coded analogously to 5003. After due deliberation in consideration of...
AF | PDBR | CY2012 | PD 2012 01935

Original file (PD 2012 01935.rtf) Auto-classification: Approved

The rating for the unfitting chronic left knee pain condition is addressed below; no additional conditions are within the DoDI 6040.44 defined purview of the Board. Chronic Left Knee Pain Condition . invalid font number 31502 SAMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXX, AR20140020828 (PD201201935) 1.
AF | PDBR | CY2014 | PD-2014-01186

Original file (PD-2014-01186.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 the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. 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. Bilateral Knee...
AF | PDBR | CY2013 | PD-2013-01846

Original file (PD-2013-01846.rtf) Auto-classification: Approved

Post-Separation) ConditionCodeRatingConditionCodeRatingExam Bilateral Knee Pain5099-50030%Left Knee Degenerative Joint Disease5010-526010%20050430Right Knee Degenerative Joint Disease5010-526010%20050430Other x 4 (Not in Scope)Other x 320050503 Combined: 0%Combined: 30%Derived from VA Rating Decision (VARD)dated 20050608 ( most proximate to date of separation) ANALYSIS SUMMARY :The Board’s authority as defined in DoDI 6040.44, resides in evaluating the fairness of Disability Evaluation...
AF | PDBR | CY2014 | PD-2014-00232

Original file (PD-2014-00232.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. Post-Separation)ConditionCodeRatingConditionCodeRatingExam Left Knee Pain PFPS5099-50030%Incomplete Tear, Left ACL, Left Knee5299-52620%20080328Other x0Other x3(Not in Scope) Combined: 0%Combined: 10%*Derived from VA...
AF | PDBR | CY2013 | PD2013 01246

Original file (PD2013 01246.rtf) Auto-classification: Approved

The PEB adjudicated “right, dominant, shoulder pain… ,” “right hip pain,” and “bilateral heel pain and right ankle pain” as unfitting, rated 10%, 0% and 0% (respectively), citing criteria of the VA Schedule for Rating Disabilities (VASRD). Post-Separation)ConditionCodeRatingConditionCodeRatingExam Right Shoulder Pain…5099-500310%Right Shoulder Arthritis5010-520110%20091125Right Hip Pain…5099-50030%Right Hip Bursitis5024-525210%Bilateral Heel Pain and Right Ankle Pain…52840%Stress Fracture,...
AF | PDBR | CY2013 | PD-2013-01299

Original file (PD-2013-01299.rtf) Auto-classification: Denied

Post-Separation)ConditionCodeRatingConditionCodeRatingExam Chronic Bilateral Knee Pain due to Chondromalacia5099-500320%Chondromalacia Patella L Knee526120%20050311Chondromalacia Patella, R Knee526120%20050311Other X 0 (Not in Scope)Other x020050314 Combined: 20%Combined: 40%Derived from VA Rating Decision (VARD) dated 20050412 (most proximate to date of separation [DOS]) ANALYSIS SUMMARY :IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability...

Search Decisions

Decision Text

AF | PDBR | CY2014 | PD-2014-01877

Similar Decisions