RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-001770
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20041013

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Military Police, medically separated for “back injury” and “left knee pain,” rated 10% and 0%, respectively, with a combined rating of 10%.

CI CONTENTION:  The CI’s conditions continue to worsen and negatively impact her daily activities.  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 conditions at the time of separation.  The panel has neither the role nor the authority to compensate for progression or complications of service connected conditions after separation.  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 - 20040615	VARD - 20050304	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Back Injury	5237	10%	Residuals of Fractured Transverse Process of L1	5235	10%	20041210	
Left Knee Pain	5099-5003	0%	Residuals of Left Knee Contusion	5099-5018	0%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Back Injury.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in February 2002 after a motor vehicle accident (MVA).  She was seen in the emergency room that day and released to quarters.  The initial X-rays were suggestive of a non-displaced fracture of the left L1 transverse process, but a follow up X-ray on 9 March 2002 was normal as was a bone scan on 11 April 2002.  The CI also had an MRI, but it did not include L1 and only covered L3-S1 in detail.  Reclassification and MEB were considered, but then delayed due to her pregnancy.  She delivered on 7 March 2004 while in the MEB process.  
The MEB NARSUM examination was dated 21 April 2004 (6 months prior to separation).  The CI reported unimproved LBP since the MVA.  On physical examination, spasm was absent.  Gait, strength, sensation, and reflexes were all normal.  The range of motion (ROM) showed a flexion to within 4 inches of the floor, which approximates 90 degrees (normal) of thoracolumbar flexion and a combined ROM of 215 degrees (normal 240).  The CI was able to heel-to-toe walk and lumbar lordosis was normal.  Tenderness was not recorded.  

At the VA Compensation and Pension (C&P) evaluation performed on 10 December 2004, 2 months after separation, the CI reported non-radiating mild low back pain with stiffness, fatigability, and weakness.  The physical examination showed a normal gait and pain-free motion.  After repetitive motion, flexion was 75 degrees and the combined ROM was 225 degrees.  There was no postural abnormality, fixed deformity, or spasm.  Musculature was normal, normal strength, no pain with resistive motion, and no change in strength with repetitive motion. Straight leg raise test was negative for radiculopathy.  Radiographic (X-rays) studies performed on 9 December 2004 were normal.  Tenderness was not documented.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5237 (lumbosacral strain), citing no significant loss of spinal motion, no radiculopathy or muscle spasm.  The VA also rated the back condition 10% coded 5235 (vertebral fracture or dislocation), citing limitation of forward flexion.  The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) and combined ROM (greater than 120 degrees but not greater than 235 degrees) reported on the MEB NARSUM and VA C&P examinations proximate to separation.  There was no muscle spasm or guarding which resulted in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the back injury condition.  

Left Knee Pain.  According to STR and the MEB NARSUM, the CI’s left knee condition also began in February 2002 after a motor vehicle accident.  An X-ray was normal as was a bone scan on 11 April 2002.  MRI studies were normal.  There were no additional records in evidence specific for the knee until the CI was entered into the MEB process.  

At the MEB NARSUM examination the CI reported continued left knee pain which was aggravated by carrying her daughter.  The physical examination was essentially normal with a normal gait, full and pain free ROM.  The knee was stable and there was no swelling.  At the C&P evaluation the CI reported ongoing left knee pain.  The physical examination was again normal as noted at the NARSUM evaluation.  X-ray studies on 9 December 2004 were normal.  The examiner noted that there was no pathology on which to base a diagnosis.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 0%, analogously coded 5003 (arthritis, degenerative), citing normal imaging, normal examination, and without loss of range of motion.  The VA also rated the left knee condition 0%, analogously coded 5018 (hydrarthrosis, intermittent), citing non-compensable evaluation.  It is not clear from the record why this code was selected by the VA rater.  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 panel 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 panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left knee pain condition.

BOARD FINDINGS:  In the matter of the back injury and left knee pain condition 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 re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150602, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170008892, 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