RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00535
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20090616

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Concrete and Heavy Asphalt Equipment Operator, medically separated from the Temporary Disability Retired List (TDRL) for “left knee pain” and “degenerative arthritis of the lumbar spine,” rated at 10% each, with a combined disability rating of 20%.   

CI CONTENTION:  No specific contention made.  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 - 20090505	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain	5099-5003	10%	No VA Examination Proximate to TDRL Removal	
Degenerative Arthritis of the Lumbar Spine	5242	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to the service treatment record (STR) and (MEB) narrative summary (NARSUM), the CI underwent a left knee lateral meniscectomy in 1998 and an anterior cruciate ligament reconstruction in September 1999.  He was placed on the TDRL at 20% for left knee pain (30% overall placement) in February 2002.

At the 21 January 2009 MEB NARSUM examination, 5 months prior to separation, the CI reported continued leg pain and that he “never got completely better” following his surgery.  Physical examination showed well-healed surgical scars.  Knee range of motion (ROM) was flexion of 130 degrees (normal 140) and extension of 0 degrees (normal).  There was no evidence of instability, and the extremity was neurovascularly intact.  A left knee MRI revealed degenerative changes with small meniscal tears and a Baker’s cyst (inflammation), and X-rays showed normal alignment and no acute processes.  

At the physical therapy (PT) appointment for MEB ROMs on 22 January 2009, flexion was 135 degrees flexion and extension was 0 degrees.  Knee pain was rated at 2/10, with no increase after repetition.  There was no VA examination proximate to TDRL removal in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee pain 10%, coded 5099-5003 (arthritis, degenerative), citing painful motion in one major joint.  Members noted there was no limitation of flexion or extension to support a rating under diagnostic codes 5260 or 5261.  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  While code 5259 (cartilage, semilunar, removal of, symptomatic) was also applicable, the maximum 10% rating provided no benefit to the CI.  There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions to support a rating under code 5258, and 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 concluded there was insufficient cause to recommend a change in the PEB adjudication for the left knee condition.  
	
Degenerative Arthritis of the Lumbar Spine.  According to the STR and MEB NARSUM, the CI’s lumbar spine condition began in February 1997 after a motor vehicle accident, and was aggravated by moving a couch in 1999.  Steroid injections in 2005 provided minimal relief and he was placed on the TDRL at 10% for degenerative arthritis of the lumbar spine in February 2005.

The 21 January 2009 MEB NARSUM examination, 5 months prior to separation, noted complaints of low back pain.  Physical examination showed pain to palpation over the lower lumbar spine with low back ROM described as “normal flexion, side bending and rotation, with 5 degrees of extension (limited by pain radiating to the buttocks).”  Motor strength and reflexes were normal.  Lumbar spine X-rays the next day showed degenerative disc and arthritic changes, and an MRI showed an annular tear (ligamentous structure surrounding the disc) with small central protrusion at L5-S1 and no significant spinal canal stenosis or neuroforaminal narrowing.  

At the PT ROM evaluation for the MEB on 22 January 2009, the CI reported low back pain rated at 5/10.  Thoracolumbar flexion was 80 degrees (normal 90) with a combined ROM of 195 degrees (normal 240), and pain at the end of motion.  There was no VA examination proximate to TDRL removal in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the degenerative arthritis of the lumbar spine 10%, coded 5242 (degenerative arthritis of the spine), citing limitation of forward flexion.  Members 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 in the PT evaluation.  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 there was insufficient cause to recommend a change in the PEB adjudication for the degenerative arthritis of the lumbar spine condition.  
BOARD FINDINGS:  In the matter of the left knee pain and degenerative arthritis of the lumbar spine conditions, and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination. 

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170213, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180007700, XXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	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