RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01035
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20091112

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Infantryman, medically separated for “arthritis lumbosacral spine” and “left knee retropatellar pain syndrome,” rated 10% and 0%, respectively, with a combined disability rating of 10%.

CI CONTENTION:  The CI requests the board consider his left knee and post-traumatic stress disorder (PTSD) conditions.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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 based upon a 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 PEB - 20090820	VARD - 20090814	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Arthritis Lumbosacral Spine with Thoracic Kyphosis	5242	10%	Arthritis Lumbosacral Spine with Thoracic Kyphosis	5242	10%	20090513	
Left Knee Retropatellar Pain Syndrome	5099-5015	0%	Left Knee Retropatellar Pain Syndrome.	5099-5015	0%	20090513	
Post-Traumatic Stress Disorder, Chronic, Mild to Moderate	Not Unfitting	Post-Traumatic Stress Disorder (PTSD)	9411	10%	20090529	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Arthritis Lumbosacral Spine.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in July 2008 after falling while performing military duties.  Radiographic studies in October 2008 revealed mild facet hypertrophy, and moderate disk bulges of the lower spine, and other findings indicative of degenerative changes.  Evaluation by orthopedics in February 2009 recommended non-surgical treatment.  Despite conservative treatment, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “kyphosis and non-radicular low back pain” for PEB adjudication.

At the 13 May 2009 VA Compensation and Pension (C&P) evaluation, performed 6 months before separation, the CI reported the left knee would give way and then “ache for a couple days.”  Physical examination showed normal gait, no limitation with repetitive motion, no objective evidence of pain with active motion, spasms, weakness or atrophy.  ROM was recorded as 90 degrees of forward flexion with a combined ROM of 220 degrees (normal 240).

The MEB NARSUM examination on 7 July 2009 (4 months prior to separation), the CI reported he was able to walk 2-3 miles without pain.  However, he was unable to wear a full rucksack or perform common soldiering tasks without suffering incapacitating pain afterwards.  The neurological examination was unremarkable.  Range of motion (ROM) testing was conducted by physical therapy 9 months before separation, and noted in the NARSUM.   The CI was able to forward flex to 75 degrees (normal 90) with a combined ROM of 175 degrees (240 normal) after three repetitions.  The examiner stated, “Pain does not cause interference with standing, sitting, or weight bearing of the bilateral lower extremity.”  

The Board directed attention to a rating recommendation based on the above evidence. The disability determination was determined under the Disability Evaluation System Pilot program, a joint initiative between the Department of Defense (DOD) and the Department of Veterans Affairs (VA).  Both the DOD and VA rated the back condition 10%, coded 5242 (degenerative arthritis of the spine). There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no evidence of intervertebral disc syndrome resulting in incapacitating episodes requiring bed rest prescribed by a physician to warrant consideration of rating under the alternate VASRD formula based on incapacitating episodes due to intervertebral disc syndrome. There were no additional codes to consider.  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 back condition.  

Left Knee Retropatellar Pain Syndrome.  According to service treatment records and the MEB NARSUM, the CI’s left knee condition began in May 2002 after he stepped into a hole and 29 December 2008, 11 months prior to separation, he underwent a magnetic resonance imaging (MRI) of the left knee which showed a “very small joint effusion and was otherwise unremarkable.”  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “left knee retropatellar pain syndrome” for PEB adjudication.

At the MEB examination (recorded on DD FormS 2807 and 2808) dated 9 March 2009, 8 months prior to separation, the CI reported that his left knee “gives out and pops sometimes.”  Physical examination showed “normal lower extremities.”  

The MEB NARSUM examination on 7 July 2009 (4 months prior to separation), the CI reported that the knee “pops and gives way.”  Physical examination noted “no evidence of atrophy, no crepitation, no instability, no patellar abnormality, or no meniscal abnormality.”  ROM documented normal flexion and normal extension.  The examiner stated, “Pain does not cause interference with standing, sitting, or weight bearing of the bilateral lower extremity.”  

At the 13 May 2009 VA Compensation and Pension (C&P) evaluation, performed 6 months before separation, the CI reported the left knee would give way and then “ache for a couple days.”  Physical examination showed normal gait and normal ROM.  There was no limitation with repetitive motion and no objective evidence of pain with active motion.  

The Board directed attention to a rating recommendation based on the above evidence.  The disability determination was determined under the Disability Evaluation System Pilot program, a joint initiative between the Department of Defense (DOD) and the Department of Veterans Affairs (VA).  Both the DOD and VA assigned a 0% rating under an analogous 5099-5015 code (benign new growths of bones), citing “normal range of motion without objective evidence of pain on motion.”  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 left knee condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that PTSD was not unfitting.  The Board first noted that the condition was adjudicated under the Pilot Disability Evaluation System, thus, the diagnosis of PTSD was rendered at the VA C&P examination and referred to the PEB for adjudication.  The C&P examiner opined that the condition of PTSD was chronic, mild to moderate. The Global Assessment of Functioning score was recorded at 68 for mild symptoms.  There was no evidence in the record that the CI participated in any form of PTSD or other mental health treatment.  The PTSD was not profiled or implicated in the commander’s statement and was not judged to fail retention standards.  There was no performance based evidence from the record that PTSD significantly interfered with satisfactory duty performance at separation.  After due deliberation, and 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 PTSD and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the “arthritis lumbosacral spine with thoracic kyphosis” condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. In the matter of the “left knee retropatellar pain syndrome” condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended PTSD 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.  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 20140221, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXXXXX AR20160009950 (PD201401035)

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:

Enclosure

CF:
( ) DoD PDBR
( ) DVA