RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01817
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060215

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E4, Light Wheeled Vehicle Mechanic, medically separated for “low back pain” and “right knee pain,” rated 10% each, with a combined disability rating of 20%.  

CI CONTENTION:  The CI attached a three page statement to his application.  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 - 20051110	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain due to Degenerative Disc Disease without Neurologic Abnormality	5299-5242	10%	No VA Exam in Evidence	
Chronic Right Knee Pain due to Chondromalacia Patella	5099-5003	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Low Back Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back pain (LBP) condition began in June 2004, when he fell down some steps getting off a troop bus.  Lumbar spine X-rays 13 January 2005 showed degenerative spinal arthritis

Magnetic resonance imaging (MRI) of the lower back in May 2005 showed a congenitally narrow spinal canal worst at L4-5 and significant degenerative disc disease throughout the lumbar spine with central spinal canal stenosis increased at L3-4, L4-5, and L5-S1.  There was contact with the exiting L5 nerve root bilaterally.  Electrodiagnostic studies performed on 23 September 2005 showed “mild, bilateral, multilevel lumbar radiculopathy.”  In the year before separation serial physical therapy evaluations noted back flexion of 36, 30, 34, 20, and 40 degrees, respectively.  The CI was diagnosed with multilevel degenerative disc disease and spinal arthritis.  Surgery was not recommended at the time.  

The 8 September 2005 MEB NARSUM examination, 6 months prior to separation, noted complaints of constant LBP with radiation down both legs, without bowel or bladder problems.  The physical examination showed an antalgic gait, which the examiner related to the right knee condition.  There was tenderness to palpation of the sacroiliac joints and the lower lumbar spine.  There was loss of the normal lumbar spinal curvature with “mild” muscle spasms on the left in the lumbar muscles.  Lower extremity sensation and reflexes were normal and there was a positive straight leg raise test to elicit radicular symptoms on the right.  Lower back range of motion (ROM) measurements performed with a goniometer on 8 September 2005 showed flexion of 42 degrees (normal 90) and combined ROM of 135 degrees (normal 240) all limited by pain.  The MEB NARSUM examiner responded to a request from the PEB for clarification and additional information on 3 January 2006.  He noted three of the PT ROM evaluations noted above and indicated that during ROM testing at the MEB NARSUM examination he had the CI warm up with some bending and stretching before taking the measurements.  They were each repeated three times.  He indicated that the CI’s muscle strength was normal bilaterally.  He also noted the result of the EMG/NCV studies after the MEB NARSUM examination and corrected the NARSUM and DA Form 3947 to reflect the CI had radicular pain to the lower extremities due to DDD. 

During 27 September 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported numbness and tingling in the low back and legs and that his left leg “wants to drag at times.”  He reported difficulty sitting or standing for long periods.  Physical examination showed “marked” decreased ROM of the lumbosacral spine.  Straight leg raise testing to elicit radicular symptoms was positive bilaterally.  

There was no VA examination in evidence proximate to separation.    

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5242 (degenerative arthritis of the spine), citing no neurologic abnormality, thoracolumbar ROM limited by pain, and tenderness to palpation.   The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees) reported on the MEB NARSUM examination.  The panel  considered whether a higher rating (§4.7) was achieved by using the alternate rating formula based on incapacitating episodes due to intervertebral disc syndrome (IVDS).  Although the CI had intervertebral disc disease there were no incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula (for IVDS).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the low back condition, coded 5242-5243 (degenerative arthritis of the spine-intervertebral disc syndrome).  

Right knee Pain:  The CI’s right knee condition began following the same incident during annual training in June 2004.  Right knee X-rays were normal and magnetic resonance imaging (MRI) done in May 2005 showed chondromalacia patella of the right knee 2005 with a small joint effusion and degenerative Baker’s cyst.  The CI was evaluated by Orthopedics and his chronic knee pain was thought to be due to chondromalacia patella, and no surgery was recommended.  

At the 8 September 2005 MEB NARSUM examination, the CI reported intermittent knee pain aggravated by prolonged standing, going up and down stairs or trying to walk over uneven terrain.  He was unable to do any running because of pain in the knee.  Physical examination showed an antalgic gait.  He had a slight limp attributed to the right knee.  Knee ROM was flexion 90 degrees (normal 140) and extension 0 degrees (normal 0) with painful motion.  There was no ligamentous laxity and meniscal signs were absent.  

There was no VA examination in evidence proximate to separation.    

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, analogously coded 5003 (arthritis, degenerative), citing ROM limited by pain, rated slight and frequent with likely application of the USAPDA pain policy.  
There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261). However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59).  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).  There was therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code.  A 10% rating is also supported under 5003 in compliance with the VASRD and no change to the PEB adjudication is recommended.  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 right knee condition.  

BOARD FINDINGS:  In the matter of the low back condition, the panel unanimously recommends a disability rating of 20%, coded 5242-5243 IAW VASRD §4.71a.  In the matter of the right knee condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Low Back Pain due to Degenerative Disc Disease 	5242-5243	20%	
Right Knee Pain due to Chondromalacia Patella	5099-5003	10%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150618, w/atchs
Exhibit B.  Service Treatment Record	

AR20170008806, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 30% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557.

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,