RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00697
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20060114

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E6, Unit Supply Specialist, medically separated for “low back pain” and “right knee pain,” rated 10% and 0%, respectively, with a combined disability rating of 10%.  

CI CONTENTION:  The CI made no 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 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 - 20050922	VARD - 20071210	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain in Low Back	5236	10%	Compression Deformity L4-L5	5299-5235	NSC	STR	
Chronic Right Knee Pain	5099-5003	0%	Patellofemoral Pain Syndrome	5099-5010	10%	20060811	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Pain in Low Back.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s low back condition began in 2001, after a fall.  MRI showed straightening of the normal lordosis, indicative of muscle spasms.  At the time of the 21 January 2005 primary care clinic appointment, 12 months prior to separation, the CI reported low back pain (LBP).  Physical examination revealed sacroiliac joints were very tender bilaterally.  

The 20 April 2005 MEB NARSUM examination, 9 months prior to separation, noted complaints of LBP, especially bad over the left hip and lower buttocks.  Physical examination showed a “very large amount of paralumbar spasm” greater on the right.  Hip examination was normal.  Thoracolumbar range of motion (ROM) measurements performed by physical therapy on 29 April 2005, 9 months prior to separation, showed flexion of 45 degrees (normal 90) and combined ROM of 120 degrees (normal 240) after repetition.  Thoracolumbar ROM was limited by pain.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5236 (sacroiliac injury and weakness), citing tenderness.  The VA determined the back condition was not service-connected.  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) and combined ROM (not greater than 120 degrees), as reported on the 29 April 2005 physical therapy 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 low back condition, coded 5236.  

Chronic Right Knee Pain.  According to the STR and the MEB NARSUM, the CI’s right knee condition began in 1989 after slipping into a hole during physical training.  MRI was normal.  At the time of the 21 January 2005 primary care clinic appointment, the CI complained of right knee pain and “pops out of place.”  Physical examination showed the CI walked in obvious discomfort and used a crutch.  Right knee was tender, but examination was otherwise normal.  The 20 April 2005 MEB NARSUM examination of the knees, 9 months prior to separation, was normal.  

At the 11 August 2006 VA Compensation and Pension (C&P) evaluation, 7 months after separation, the CI reported constant right knee pain and stated that his knee “gives out once in a while.”  CI reported walking with a cane 100% of the time.  Physical examination revealed crepitus, tenderness, painful movement and abnormal motion in the right knee (antalgic gait).  ROM showed flexion of 130 degrees (normal 140) and extension of 0 degrees (normal 0).  Pain on active motion and abnormal tracking of the patellar were noted.  X-ray evaluation showed osteoarthritis.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, analogously coded 5003 (degenerative arthritis), citing pain that was minimal and frequent IAW the US Army Physical Disability Agency pain policy.  The VA rated the right knee condition 10%, analogously coded 5010, (arthritis, due to trauma), based on the C&P examination 7 months after separation, citing evidence of limited motion.  

The VA examination demonstrated painful motion; however, the panel noted that painful motion was not noted on multiple examinations prior to separation.  The orthopedic examination noted a normal knee examination except for tenderness to palpation.  The NARSUM examination noted a normal knee examination. Panel member placed higher value on the pre-separation examinations.  The panel agreed 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 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).  The STR did not support painful motion. 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, the panel recommends a disability rating of 20%, coded 5236 IAW VASRD §4.71a.  In the matter of the right knee condition 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.  

The panel recommends 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 Pain In Low Back	5236	20%	

The following documentary evidence was considered:  

Exhibit A.  DD Form 294, dated 20170211, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Treatment Record  

AR20180004745, 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