RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01727
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070306

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E5, Motor Transport Operator, medically separated for “chronic low back pain” (LBP) and “chronic left knee pain,” rated 10% and 0%, respectively, with a combined disability rating of 10%.  

CI CONTENTION:  The CI made no specific contention.  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 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 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 - 20070123	VARD - 20070604	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Lumbar Degenerative Disc Disease (DDD)	5243	10%	20070324	
Chronic Left Knee Pain	5099-5003	0%	Left Knee Degenerative Joint Disease (DJD)	5010	0%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

LBP.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s LBP condition began in October 2004 after running and falling into a hole.  Radiographic studies showed degenerative changes and some mild narrowing of the L5-S1.  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 “chronic low back pain” for PEB adjudication.  

Thoracolumbar ROM
(Degrees)	PT ~8 Mos. Pre-Sep	MEB ~6 Mos. Pre-Sep	VA/PT ~2 Wks. Post-Sep	
Flexion (90 Normal)	50 (50, 50, 50)	“Limited in flexion and extension”	90	
Combined (240)	125	-	240	
Comments	Painful motion
 	Painful motion
Normal gait	No Painful motion
Normal gait	
§4.71a Rating	20%	0%	0%	

The MEB NARSUM examination on 22 September 2006, 6 months prior to separation, noted complaints of sharp pain radiating from his back down to right leg.  The CI noted that his pain contributed to right lower extremity numbness and loss of strength.  The physical examination showed a normal, non-antalgic gait. He had limited range of motion of his lumbar spine, mainly limited in flexion and extension due to pain.  He had no step-off or deformity about his lumbar spine to palpation.  Neurologic: There was 5/5 muscle strength in all major muscle groups to the lower extremities with 2/4 deep tendon reflexes at his ankles and knees bilaterally.  Light touch sensation was intact throughout all extremities. The patient had a mildly positive straight-leg raise bilaterally.  However, this seemed to be mostly due to hamstring tightness.  At the 24 March 2007 VA Compensation and Pension (C&P) evaluation, performed 2 weeks after separation, the CI reported constant, aching, burning and sharp pain.  The CI’s involvement in physical activity elicited his pain, only relieved with rest and over-the-counter medications.  The physical examination revealed no evidence of radiating pain on movement or muscle spasm.  No tenderness was noted.  There was negative straight leg raising test on the right and left.  There was no ankylosis of the lumbar spine.  The range of motion of the lumbar spine was as follows: flexion 90 degrees; extension 30 degrees; right lateral flexion 30 degrees; left lateral flexion 30 degrees; right rotation 30 degrees; left rotation 30 degrees.  The joint function of the spine was not additionally limited by pain, fatigue, weakness, lack of endurance or incoordination after repetitive use.  There was symmetry of spinal motion with normal curvatures of the spine.  There were no signs of intervertebral disc syndrome with chronic and permanent nerve root involvement.  CI’s posture and gait were within normal limits.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP condition 10%, coded 5237 (lumbosacral strain), citing tenderness and limitation of motion (LOM) due to pain.  The VA rated the LBP condition 0% coded 5243 (intervertebral disk syndrome), based on the VA C&P examination 2 weeks after separation, citing a normal examination with a forward flexion greater than 85 degrees, no pain, spasm or tenderness.  The Board agreed that the C & P examination carried greater probative value due to its proximity to the CI’s separation.  The examination was thorough, well documented and showed normal ROM and no back pain, spasm or tenderness.  There was no forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or vertebral body fracture with loss of 50 percent or more of the height to justify a rating of 10%.  There was no evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  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 LBP condition.  

Left Knee.  According to STR and the MEB NARSUM, the CI’s left knee condition began in October 2004 while running and falling into a hole.  Radiographic studies showed a stable and mild compartment narrowing.  Despite treatment, the left knee 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 “chronic left knee pain” for PEB adjudication.  The MEB NARSUM examination noted complaints of aching and swelling of left knee with activities.  The CI denied any instability.  The physical examination revealed no effusion.  He had an active extension ROM from 0 to 115 degrees (140 normal) and passive ROM to 125 degrees with some pain.  He had some tenderness to palpation about his anteromedial aspect of his knee, particularly over the medial femoral condyle.  He had no joint line tenderness.  The knee was stable to varus and valgus stress as well as anterior and posterior drawer.  He had a negative Lachman and negative pivot shift.  There were 3/5 non organic signs for a positive axial load, exaggeration and distraction.  At the 24 March 2007 C&P evaluation the CI reported pain, stiffness and giving way with running.  The physical examination of the left knee showed no signs of edema, effusion, weakness, tenderness, redness, heat, abnormal movement, subluxation or guarding of movement.  There was no recurrent subluxation, 'locking' pain, joint effusion or crepitus.  The range of motion of the knee joint was as follows: flexion 140 degrees (140 normal); extension 0 degree.  The joint function was not additionally limited by pain, fatigue, weakness, lack of endurance or incoordination after repetitive use.  The anterior and posterior cruciate ligaments and medial and lateral collateral ligaments stability tests were within normal limits.  The medial and lateral meniscus test was within normal limits.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee 0%, analogously coded 5099-5003 (degenerative arthritis), citing pain limited ROM with no instability.  The VA rated the left knee 0% coded 5010 (arthritis due to trauma), based on the C&P examination 2 weeks after separation, citing a normal examination.  The Board agreed that the C&P examination carried greater probative value due to its proximity to the CI’s separation.  The exam was thorough, well documented and showed normal ROM and no painful motion, weakness, lack of endurance, or tenderness.  There was no evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  There likewise was no limitation of motion which attained a minimum rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), and 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 malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  No additional functional limitation was evidenced by the examinations.  Therefore the Board concluded there was not sufficient evidence to support a rating higher than the 0% adjudicated 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 adjudication for the left knee condition.  

BOARD FINDINGS:  In the matter of the chronic 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 left 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 20150630, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170005122, XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	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