RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01644
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20041215

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,” “right hip pain” and “right knee pain,” rated 10%, 0%, and 0%, respectively, with a combined disability rating of 10%.   

CI CONTENTION:  The CI made no specific contention.  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 it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB – 20041101	VARD - 20051207	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Degenerative Joint and Disc Disease, Lumbar Spine	5242-5243	10%	20050816	
Right Hip Pain	5019	0%	Right Hip Bursitis	5019-5252	10%		
Right Knee Pain	5099-5003	0%	Right Knee Injury	5260	10%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in July 2003 after falling.  An MRI study demonstrated degenerative disc changes at L1-2 and a moderate disc protrusion at L5-S1 resulting nerve root impingement.   

The 27 August 2004 MEB NARSUM examination, 4 months prior to separation, noted complaints of lower back pain radiating to the right thigh with spasms.  There was no back examination.  The 8 October 2004 physical therapy range of motion (ROM) study, 2 months prior to separation, showed flexion of 80 degrees (normal 90) and a combined ROM of 210 degrees (normal 240).  Pain on motion was not addressed. 

At the 7 December 2005 VA Compensation and Pension (C&P) evaluation, 8 months after separation, the CI reported chronic lower back pain radiating to the right thigh and intermittent right paraspinal muscle spasms.  Physical examination showed moderate lumbosacral muscle spasm, guarding and tenderness.  The examiner noted the spasms and guarding were severe enough to result in an abnormal gait, but spinal contour was normal.  Thoracolumbar ROM was flexion of 60 degrees and combined ROM of 125 degrees.  There was pain in all planes of motion.  There was an addition 5-degree loss of extension and flexion with repetitive motion due to pain.  

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 degenerative disc disease without neural impingement, no spasm or radiculopathy and flexion limited to 80 degrees.  The VA also rated the back condition 10%, coded 5242-5243, (degenerative arthritis of the spine and intervertebral disc syndrome), citing limitation of forward flexion.  

The panel placed higher probative value on the NARSUM and in service physical therapy examinations because they were closer to the time of separation than the VA examination.  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 as reported on the physical therapy examination.  Although the NARSUM noted muscle spasm, it was not severe enough to result 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 there was insufficient cause to recommend a change in the PEB adjudication for the back condition.  

Right Hip Pain.  According to the STR and the MEB NARSUM, the CI’s right hip condition began in July 2003 after falling.  An orthopedic examination on 6 July 2004 noted full, active, painful right hip motion and greater trochanteric tenderness.  The 27 August 2004 MEB NARSUM examination, 4 months prior to separation, noted complaints of right hip pain.  Physical examination showed right hip flexion (passive) to 100 degrees (normal 125) with pain at the greater trochanter.  

At the 7 December 2005 C&P evaluation the CI reported intermittent giving way because of severe right hip pain.  Physical examination showed right hip ROM of flexion to 60 degrees, extension to 30 degrees, abduction to 30 degrees (normal 45) and adduction to 15 degrees (normal 45) with painful motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right hip condition 0%, coded 5019 (bursitis), citing no loss of joint motion.  The VA rated the right hip condition 10%, dual coded 5019-5252, (bursitis and limitation of flexion of thigh), based on the C&P examination 8 months after separation, citing painful motion.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion, extension, abduction or adduction (5251, 5252, 5253).  However, there was 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 panel recommends a disability rating of 10% for the right hip condition, coded 5019.  

Right Knee Pain.  According to the STR and the MEB NARSUM, the CI’s right knee pain condition began in began in July 2003.  At the 6 July 2004 orthopedic examination the CI reported right knee pain and popping.  Physical examination showed positive patellofemoral grind (knee pain with compression of the patella), quadriceps inhibition (inability to fully activate the quadriceps muscles) and crepitus.  There was full knee ROM.  Painful motion was not addressed.  The MEB NARSUM examination noted complaints of right knee pain with locking, giving out, and swelling.  The CI reported use of a knee brace.  Physical examination showed right knee flexion to 135 degrees (normal 140).  At the C&P evaluation the CI reported chronic right knee pain.  Physical examination showed right knee flexion to 115 degrees and extension to 0 degrees.  There was pain with flexion.  There was no significant joint line tenderness.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee pain condition 0%, coded analogous to 5003 (degenerative arthritis), citing normal radiographic studies and full joint motion.  The VA rated the right knee condition 10%, coded 5260, (limitation of flexion of leg), citing painful motion.  The panel placed higher probative value on the NARSUM and in-service orthopedic examinations because they were closer to the time of separation than the VA examination.  There was no limitation of motion which attained a 10% rating under the diagnostic codes for limitation of flexion or extension (5260, 5261) and no evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  Therefore, the panel concluded there was insufficient 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 there was insufficient cause to recommend a change in the PEB adjudication for the right knee condition.  

BOARD FINDINGS:  In the matter of the back condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the right hip condition, the panel unanimously recommends a disability rating of 10%, coded 5019 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, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Low Back Pain	5237	10%	
Right Hip Pain	5019	10%	
Right Knee Pain	5099-5003	0%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161027, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180002652, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

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