RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00573
BRANCH OF SERVICE:  army	SEPARATION DATE:  20021223

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Automated Logistics Specialist, medically separated for “left knee pain," rated at 10%.  “Mechanical low back pain” was determined to exist prior to service (EPTS) and was not rated.   

CI CONTENTION:  The CI contends he continues to suffer from the effects of his knee and back pain.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination is based on 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(s) at the time of separation.  The panel 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 panel 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 - 20020927	VARD - 20030722	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain..	5099-5003	10%	Osgood-Schlatter, Left Knee…	5257	0%	STR	
Mechanical LBP	5299-5295	EPTS	Low Back Condition	5295	NSC		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee pain condition began in July 2001 after a run.  He received conservative treatment but re-injured his knee when another soldier fell into his knee.  Magnetic Resonance Imaging (MRI) in December 2001 showed abnormal fluid collection representing a possible cyst and questionable cartilage (medial meniscus) injury.  Orthopedics recommended injection of pain killing medications but they were not beneficial.  The MEB forwarded “left anterior knee pain” for PEB adjudication.  

The MEB NARSUM examination on 9 August 2002, 5 months prior to separation, noted complaints of constant left knee pain, rated 3/10 in  severity that could worsen to 10/10 with running and other activities.  There was mild increase in pain with standing or walking for prolonged periods.  There was no improvement with injections or physical therapy.  Physical examination showed normal alignment and normal gait.  There was no effusion (buildup of fluid in the joint) or ligamentous laxity noted.  There was tenderness of the knee joint.  Pulse and sensation were intact.  Range of motion (ROM) testing by Physical Therapy (PT) showed flexion to 135 degrees (normal 140) and extension to 0 degrees (normal).  There was no evidence the VA performed a Compensation and Pension (C&P) examination proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee pain condition 10%, coded 5099-5003 (degenerative arthritis).  The VA rated left knee condition 0% coded 5257 (knee, other impairment of).  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  There was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), or history of surgery to remove a meniscus (5259) to support a rating under the respective codes.  There was no fracture, non-union, or mal union of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  There was therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code, and no grounds for additional rating based on the presence of instability.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the left knee condition.

Mechanical LBP. According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back pain began in June 2002.  Radiographic study (X-ray) performed in July 2002 indicated possible low back compression fractures and disc space narrowing.  Bone scan of the lumbar spine was normal, showing no active fractures, indicating they represented old, healed injuries, though the CI did not recall any old injuries.  The MEB forwarded “mechanical low back pain” for PEB adjudication.  The MEB NARSUM examination on 9 August 2002, 4 months prior to separation, noted complaints of low back pain with physical activities.  Physical examination showed tenderness in the lower back but no muscle spasms.  Testing for nerve root impingement was negative.  Reflexes and sensation were intact and strength was 5/5.  Range of motion testing showed flexion to 90 degrees (normal 90) and combined ROM to 220 degrees (normal 240).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB determined the back condition was EPTS and used the 5299-5295 code (analogous to lumbosacral strain), citing normal range of motion and the presence of old compression fractures.  The VA determined the low back pain condition was not service-connected and used a non-analogous 5295 code.  After a thorough review of the evidence of record, the panel was unable to find objective evidence of service aggravation of the CI's low back pain.  Therefore, after due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication of the mechanical low back pain condition.  

BOARD FINDINGS:  In the matter of the left knee pain and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the mechanical low back pain and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150604, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170004845 , XXXXXXXXXXXXXXXXXX 

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Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					       
						      					
Enclosure