RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00532
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20060606

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E4, Military Police, medically separated for “chronic non-radiating low back pain” and “chronic right knee pain” rated 0% each, with a combined disability rating of 0%.   

CI CONTENTION:  “Please review.”  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20060511	VARD - 20070323	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic…Low Back Pain	5237	0%	Lumbar Degenerative Disc Disease	5242	10%	20061107	
Chronic Right Knee Pain	5099-5003	0%	Right Knee Tendonitis…	5024-5260	10%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Low Back Pain (LBP).  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s LBP condition began in 2003 from a parachute jump, and he reinjured the back again in December 2004 by heavy lifting.  Radiographic studies were normal and showed no intervertebral disc herniation.  Evaluation by orthopedics concluded with a diagnosis of lumbago (non-specific back pain) and recommended non-surgical treatment.  During the 1 June 2005 primary care examination, 12 months prior to separation, the CI reported LBP radiating to the left knee when aggravated.  Physical examination showed thoracolumbar spine tenderness localized to the right paraspinal muscles at T-8-T10 and the left paraspinal muscles at L2-L5.  Thoracolumbar spine range of motion (ROM) was full and there was no painful motion.  At the 28 June 2005 primary care examination the CI reported LBP radiating to the left knee when aggravated.  Physical examination showed a normal gait and “excellent” ROM of the back with flexion, extension, and side to side bending.  There was tenderness.  At the 4 July 2005 primary care examination the CI reported 2/10 LBP and that Percocet and Flexril were the only drugs that helped with pain, and he sometime took more than the prescribed amount.  Physical examination showed his back ROM was “pretty good” with normal side to side bending and normal forward flexion and back extension.  At the 13 July 2005 primary care examination, 11 months prior to separation, the CI reported his back pain was 3/10 and his back pain “comes and goes.”  He would get a sharp flank pain intermittently and then it resolved.  Physical examination showed “full ROM with flexion and extension and side to side bending.  No stiffness was noted.”  

During the 21 March 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, physical examination showed a normal gait.  The CI was able to transition from sitting to standing and get on and off the examination table with ease.  The 12 April 2006 physical therapy (PT) examination, 2 months prior to separation, recorded ROMs taken for the MEB.  Flexion was 45 degrees (normal 90) and combined ROM was 180 degrees (normal 240).  The examiner noted the CI had a sharp pain with extension and when coming up from the flexed position.   There was a consistent left sided lower back popping sensation.  The 20 April 2006 MEB NARSUM examination record was incomplete with regards to the back condition.  

At the 7 November 2006 VA Compensation and Pension (C&P) evaluation, 5 months after separation, the CI reported intermittent back pain aggravated by cold weather, sitting or standing for more than 30 minutes, and lifting.  Physical examination showed normal posture and normal spinal alignment and contour.  An absence of tenderness was noted.  ROM was recorded as flexion to 90 degrees and combined ROM of 240 degrees (normal), with painful motion noted.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP 0%, coded 5237 (lumbosacral strain), citing pain limited motion.  The VA rated the LBP condition 10%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination.  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), as reported on the PT examination.  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 LBP condition, coded 5237.  

Chronic Right Knee Pain.  According to the STR and MEB NARSUM, the CI underwent right knee surgery in July 1999 for a torn lateral meniscus (cartilage between the shin bone and thigh bone).  During the 21 March 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, physical examination showed gait within normal limits and no limp.  The CI was able to transition from sitting to standing and get on and off the examination table with ease.  Muscle strength of the right lower extremity was normal.  At the PT clinic appointment on 12 April 2006, 2 months prior to separation, ROM was recorded as 0-132 degrees (normal 0-140), with complaints of painful motion by the CI during ROM measurements.  The 20 April 2006 MEB NARSUM the following week, 2 months prior to separation, listed CI complaints of increasing right knee pain, swelling, and mechanical locking.  Physical examination revealed no tenderness, spasm, effusion, or instability of the knee.  ROM was recorded as 0-135 degrees.  There was no mention of painful motion.  

At the 7 November 2006 C&P evaluation the CI reported worsening daily knee pain with intermittent stiffness, locking, and occasional swelling, aggravated by stairs, running, prolonged sitting, and cold weather.  Physical examination showed mild tenderness on the side of the kneecap as well as crepitus (popping or grinding noise or sensation in the joint), but no swelling.  ROM was recorded as being “intact” with painful motion recorded at a flexion of 135 degrees.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, coded 5099-5003 (analogous to degenerative arthritis), citing “pain minimal, occasional” (criteria of the US Army Physical Disability Agency pain policy [AR 635-40]).  The VA rated the right knee condition 10%, coded 5024-5260 (tenosynovitis – limitation of leg flexion).  

There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to support a rating under that code.  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).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  The 5259 code (cartilage, semilunar, removal of, symptomatic) was also applicable in this case, and provided an alternate route to a 10% rating but no benefit to the CI.  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 knee condition, coded 5099-5003.   

BOARD FINDINGS:  In the matter of the chronic LBP, the panel recommends a disability rating of 20%, coded 5237 IAW VASRD §4.71a.  In the matter of the chronic right knee pain, the panel recommends a disability rating of 10%, coded 5099-5003 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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Non-Radiating Low Back Pain	5237	20%	
Chronic Right Knee Pain	5099-5003	10%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170212, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180004700, 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 and to the counsel you listed on your application, XXXXXXXXXXXXXXXXXX.

Sincerely,					      
Enclosure