RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02580
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040525

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6, Light Wheeled Vehicle Mechanic, medically separated for “chronic subjective mechanical low back pain” and “chronic bilateral knee pain” with a disability rating of 10% each condition for a combined rating of 20%.

CI CONTENTION:   The CI contends both his knees, foot, sleep apnea and right shoulder conditions.  His 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 - 20040317	VARD - 20040602	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Subjective Mechanical Low Back Pain	5299-5237	10%	Degenerative Disc Disease L4-L5	5242	10%	20040325	
Chronic Bilateral Knee Pain	5099-5003	10%	Osteoarthritis Changes, Left Knee	5003-5024	10%	20040325	
			Osteoarthritis Changes, Right Knee	5003-5024	10%	20040325	
COMBINED RATING:  20%	COMBINED RATING FOR ALL VA CONDTIONS:  40%	

ANALYSIS SUMMARY:

Mechanical Low Back Pain (LBP).  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM) the CI’s LBP condition began in 2002 without a specific event or injury cited.  X-rays revealed mild degenerative disc disease (DDD) of the lower lumbar spine.  Despite conservative treatment to include manipulations, his back pain continued.  He was given a L3 profile and referred to the MEB.
At the MEB NARSUM examination performed on 03 March 2004, 3 months before separation, the CI reported continued LBP causing the inability to wear any personal protective gear to include a rucksack.  The physical examination was essentially normal noting minimal decreased thoracolumbar range of motion (ROM) in extension and lateral flexion.  At the VA Compensation and Pension (C&P) examination performed on 25 March 2004, 2 months prior to separation, the CI reported constant LBP associated with stiffness and weakness without pain extension into either lower extremity.  The physical evaluation revealed a normal gait and normal but painful thoracolumbar ROM.  Additionally, there was tenderness without spasm about the lower spine.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the mechanical LBP 10% coded 5237 (lumbosacral strain).  The VA also rated the mechanical LBP 10% coded 5242 (degenerative arthritis) based on the VA C&P 2 months before separation, citing spinal tenderness and painful motion.

The Board agreed there was insufficient limitation of motion to support a minimum rating under the General Rating Formula for Diseases and Injuries of the Spine; however, the a 10% rating was justified for functional loss (4.40) due to the painful motion (4.59) documented by the VA C&P examination.  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 documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula or evidence of ratable peripheral nerve impairment which would provide for additional rating.

Chronic Bilateral Knee Pain.  The CI sustained two separate sport related injuries to his knees; left knee in 1998 and the right knee in 2002.  Serial X-rays revealed mild degenerative changes within both knees.  Persistent and unrelenting bilateral knee pain remained and the CI’s condition was referred to the MEB.  The MEB NARSUM physical examination of both knees were detailed and completely normal except for decreased bilateral knee ROM of flexion 130 degrees (normal 140); painful motion was not addressed.  The VA C&P examination, 2 months prior to separation, revealed bilateral knee tenderness.  Swelling, effusion, instability and or painful motion were not present.  ROM was measured as flexion to 130 degrees and extension to 0 degrees, bilaterally.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral knee pain condition 10% analogously coded 5099-5003 (degenerative arthritis) citing slight/constant pain.  The VA rated each knee separately at 10%, both analogously coded 5003-5024 (degenerative arthritis - tenosynovitis) based on the VA C&P examination, 2 months before separation, citing limited motion of a major joint.  The Board first considered whether each knee condition remained separately unfitting, having decoupled them from the combined PEB adjudication.  In consideration of separate ratings, the Board must also consider separate fitness assessments which justify each disability rating.  The Board acknowledged that the sole remarkable physical examination finding of local tenderness did not specifically and singularly warrant any positive impairment rating.  This case revealed minimal evidence which was equivocal for each knee near the time of separation.  Although it is speculative to conclude that the disability confined to the either knee would have rendered the CI incapable of performing within his occupational rating, the Board agreed that it was also reasonable to surmise that it was the overall effect of both knees which rendered him unfit; and, therefore neither knee could be found reasonably justified as separately unfitting.

The Board concluded that the bilateral diagnosis did support a single 5003 based rating for “2 or more major joints,” as conferred by the PEB.  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’s adjudication of the bilateral knee condition.

BOARD FINDINGS:  In the matter of the mechanical low back pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the chronic bilateral knee pain 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.  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 20140527, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160016878 (PD201402580)

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