RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01397
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061206

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Reserve O2, Personnel Systems Management Officer, medically separated for “chronic low back pain…” and “chronic left knee pain…,” rated 10% and 0%, respectively, with a combined disability rating of 10%.

CI CONTENTION:  The CI contends for conditions not identified by either the MEB or PEB.  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 - 20061108	VARD - 20080221	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5242	10%	Lumbar Strain…	5237	10%	20070330	
Chronic Left Knee Pain	5099-5003	0%	Left Knee  Chondromalacia	5260	10%*	20070330	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	
*raised from 0% to 10%, retroactive to separation, on 20080731 Review after appeal

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the initial evaluation was for left leg pain and both electro-diagnostic studies and magnetic resonance imaging (MRI) were normal.  The range of motion (ROM) in an orthopedic examination on 13 July 2006 was normal.  A repeat MRI on 20 July 2006 showed minimal multi-level degenerative disc disease (DDD) and degenerative joint disease (DJD).  Disc herniation was not present.  Despite 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 MEB.  The MEB forwarded “lumbago” for PEB adjudication.  The MEB examination on 12 October 2006 was significant for paraspinal tenderness with a normal neurological examination.  The MEB NARSUM examination performed on 31 October 2006, 2 months prior to separation, the CI reported that the back condition began in May 2005 after doing an abdominal workout.  He reported pain with normal daily activities that increased if he over-exerted himself.  On examination, lumbar spine and paraspinal muscle tenderness were present.  Strength was reduced on the left with flexion of the knee (below).  At the VA Compensation and Pension (C&P) evaluation performed on 3 April 2007, 3 months after separation, the CI reported back pain that is progressively getting worse. He denied incapacitation and worked as a farmer.  On examination, he had a normal gait and was able to doff and don his clothes and shoes without apparent difficulty.  Tenderness was noted in the lumbosacral region.  The ROM was limited and minimally painful.  The neurological examination was normal.  The ROM examinations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.  

Thoracolumbar ROM
(Degrees)	PT ~3 Mos. Pre-Sep	VA ~3 Mos. Post-Sep	
Flexion (90 Normal)	90	80	
Combined (240)	210	205	
Comments	Painful motion and tenderness	Painful motion and tenderness	
§4.71a Rating	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5299-5242 (degenerative arthritis of the spine), citing positive tenderness.  The VA rated the back condition 10% coded 5237 (lumbosacral strain), based on the VA C&P examination 3 months after separation, citing limitation of motion ·of the lumbar spine.  The criteria for a higher rating were not present.  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.  

Chronic Left Knee Pain.  The records show that the CI underwent left knee surgery in May 2005 and was found to have degenerative changes of the cartilage lining the knee and kneecap.  Following surgery, he underwent rehabilitation but could return to full duty.  Despite treatment, the knee 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 “patella femoral pain syndrome” for PEB adjudication.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated 12 October 2006, 2 months prior to separation, the CI reported pain with activity.  On examination, there was mild crepitus of left knee and decreased strength in flexion secondary to pain.  At the NARSUM examination, the CI reported that he had injured his left knee in a Scout Leaders Course in October 2004.  Despite treatment, his pain had progressed from the initial injury.  On examination, crepitus (an audible or sensible grating sensation) was present.  The ROM was reduced as charted below and obtained in physical therapy.  X-rays were normal.  The VA C&P examination noted continued pain.  The CI reported locking and giving was as well.  As noted above, his gait was normal and he was able to don and doff his clothing without difficulty.  The ROM was reduced as charted below and painful at the extremes of motion.  The knee was stable and signs of meniscal irritation negative.  There were no further limitations with repetition.  The ROM examinations 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)	MEB ~2 Mos. Pre-Sep	VA C&P ~3 Mos. Post-Sep	
Flexion (140 Normal)	130	120	
Extension (0 Normal)	-5	0	
Comment	Limited by pain 	Pain at extreme range of motion	
§4.71a Rating	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the knee condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing limitation of motion.  The VA also rated the knee condition 0% coded 5260 (leg limitation of flexion), based on the VA C&P examination 3 months after separation, citing limitation of forward flexion.  However, the VA later rated the knee at 10%, retroactive to separation, following a review in response to a Notice of Disagreement filed by the CI.  The Board noted that the ROM was painful on both examinations.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt) and VASRD §4.58 (painful motion), the Board recommends a disability rating of 10% for the chronic left knee pain condition, coded 5299-5260.  

BOARD FINDINGS:  In the matter of the back condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the knee condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5260 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Low Back Pain	5299-5242	10%	
Chronic Left Knee Pain	5299-5260	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140303, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXX, AR20160011459 (PD201401397)

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, accept the Board’s recommendation to modify the individual’s disability rating to 20% without re-characterization 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:

CF: 
(  ) DoD PDBR
(  ) DVA