RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00760
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20040604

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Combat Engineer, medically separated for “long standing low back pain” and “chronic left knee pain,” rated 10% and 0%, respectfully, with a combined disability rating of 10%.

CI CONTENTION:  The CI makes no contentions.  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 - 20040406	VARD - 20050214	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Long Standing Low Back Pain	5237	10%	Low Back Strain…	5237	20%	20040917	
Chronic Left Knee Pain	5099-5003	0%	Left Knee, Partial…Meniscectomy	5260	10%	20040917	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

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 began in 1994 with no specific injury or trauma identified.  There was no surgical indication.  The 17 February 2004 MEB NARSUM examination, 4 months prior to separation, noted complaints of mechanical low back pain with no radicular symptoms.  Physical examination showed pain at L4-5 vertebrae level.  Straight leg raise test for radiculopathy and nerve root impingement was negative, but a femoral nerve stretch test was positive for potential nerve impingement.  Range of motion (ROM) measurements were performed by physical therapy, but were not found in evidence.  During the 23 February 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, physical examination showed “decreased range of motion” with spinal tenderness.

At the 17 September 2004 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported no chronic back pain, but pain manifested when bending, lifting, or sitting or standing for greater than 30 minutes.  The CI denied radiating symptoms.  Physical examination showed pain in the midline of the back.  ROM was flexion to 70 degrees (normal 90) and combined ROM to 215 degrees (normal 240) with painful motion.  Testing for nerve root impingement was negative, and the neurologic examination was normal.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5237 (lumbosacral strain), citing no significant limitation of motion, but the presence of spinal tenderness.  The VA rated the low back condition 20%, also coded 5237, based on the C&P examination 3 months after separation, citing limitation of 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), as reported on the VA examination, which was the only complete examination proximate to separation.  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.  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 low back pain condition.

Left Knee Pain.  According to the STR and the MEB NARSUM, the CI underwent a second left knee surgery in August 2003 for a torn medial meniscus (a similar unsuccessful surgery was performed 2 months earlier).  At the 8 January 2004 orthopedic clinic appointment, 5 months prior to separation, the CI reported left knee pain that prevented him from performing duties or participating in physical fitness tests.  Physical examination revealed left knee tenderness and pain.  Testing for ligamentous instability was negative.  ROM was flexion to 130 degrees (normal 140) and extension to 0 degrees (normal 0); painful motion was not addressed.  At the 17 February 2004 MEB NARSUM, physical examination revealed left knee tenderness without ligamentous instability.  ROM was flexion to 130 degrees and extension to 0 degrees; painful motion was not addressed.  During the 23 February 2004 MEB examination the physical examination showed left knee tenderness and the CI was wearing a knee brace.

At the 17 September 2004 C&P evaluation the CI reported constant knee pain which increased with prolonged walking, climbing stairs or ladders, bending, or squatting.  He reported using a knee brace daily but did not use a cane.  Physical examination revealed ROM of flexion to 115 degrees and flexion to 5 degrees with painful motion.  There was no lateral knee instability.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing degenerative arthritis without loss of joint motion.  The VA rated the left knee condition 10%, coded 5260 (leg, limitation of flexion), based on the C&P examination 3 months after separation, citing limitation of leg flexion.  The panel agreed that there was evidence of meniscal cartilage removal under the 5259 code (cartilage, semilunar, removal of, symptomatic) to support a 10% rating.  Although there was meniscal cartilage removal, there was no documented post-surgical frequent episodes of “locking,” pain, and effusion into the joint to support a 20% rating under code 5258.  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 fracture, nonunion or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the left knee condition, coded 5259.

BOARD FINDINGS:  In the matter of the long standing low back pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the chronic left knee pain, the panel unanimously recommends a disability rating of 10%, coded 5259 IAW VASRD §4.71a.  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, effective as of the date of the prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Long Standing Low Back Pain	5237	10%	
Chronic Left Knee Pain	5259	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160913, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170017583, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

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

Sincerely,	
Enclosure