RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX  	CASE:  PD-2017-00823
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070218

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Military Policeman, medically separated for “chronic lumbar degenerative disc disease (DDD)” and “chronic left knee pain,” both rated 0%, with a combined disability rating of 0%.  

CI CONTENTION:  No specific contention was 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 - 20061005	VARD - 20070621	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Lumbar DDD	5243	0%	Status Post Lumbar Surgery with Lumbar Strain	5237	20%	20070403	
Chronic Left Knee Pain	5099-5003	0%	Left Knee Condition	5261	NSC	20070403	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Lumbar DDD.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent L5-S1 discectomy surgeries in April 2004 and August 2005.  The 9 May 2006 MEB NARSUM examination, 9 months prior to separation, noted complaints of low back pain (LBP).  Physical examination showed well-healed surgical incisions, with tenderness over the lower lumbar spine.  Heel and toe walk and gait were intact, Waddell signs were 3/5.  There was decreased light touch sensation in the left lower extremity in L3-L4 and S1 distributions.  

Thoracolumbar range of motion (ROM) measurements performed by physical therapy (PT) on 26 July 2006, 7 months prior to separation, showed flexion of 75 degrees (normal 90) and combined ROM of 190 degrees (normal 240) after repetition, with severe pain noted on passive ROM.  At the 8 August 2006 pain management consultation the CI reported 4/10 back pain with radiation to his left leg and foot.  Physical examination showed full ROM with increased pain at 60 degrees of flexion.  The CI was diagnosed with post laminectomy pain syndrome.  The CI underwent fluoroscopic nerve block on 19 October 2006, trial epidural cord placement on 22 December 2006, and epidural stimulation insertion on 11 January 2007.  At the 7 February 2007 pain management follow-up the CI reported “good pain relief with the spinal cord stimulator.”  

At the 3 April 2007 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported moderate intermittent LBP occurring approximately twice per week with a duration of up to a half hour.  Physical examination showed mild to moderate lumbar spine pain and spasms.  Thoracolumbar ROM measurements recorded active flexion to 60 degrees and combined ROM of 210 degrees with no additional limitation due to pain, fatigue, weakness, or lack of endurance after repetitive motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 0%, coded 5243 (intervertebral disc syndrome), citing some reported tenderness with combined passive ROM equal to 363 degrees, including painful flexion to 90 degrees.  The VA rated the back condition 20%, coded 5237 (lumbosacral strain), based on the C&P examination, citing forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees.  

The panel noted that the PT MEB ROMs were prior to the October 2006 surgical procedure and met criteria for a 10% rating for painful motion and limitation of forward flexion greater than 60 degrees, but not greater than 85 degrees.  The panel then considered the post-surgical evidence.  The pain management follow-up examination, one month post stimulator insertion and 12 days prior to separation noted reports of 0-1/10 pain.  The physical examination showed a well healing back wound and did not note post-surgical ROM; therefore the panel placed higher probative value on the VA examination, 3 months after the stimulator insertion.  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.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the back condition, coded 5243.  

Chronic Left Knee Pain.  According to the STR and MEB NARSUM, the CI’s knee condition began in February 2006 after a motor vehicle accident.  The 7 July 2006 MRI was normal.  The 25 July 2006 nerve conduction study demonstrated chronic, old left L5-S1 radiculopathy involving the gastrocnemius (calf muscle) and gluteus maximus (buttock).  

The MEB NARSUM examination noted complaints of left knee pain, predominantly in the lateral aspect of the knee, with occasional painful popping and clicking.  Physical examination showed tenderness at the lateral joint line and a positive McMurray’s sign (meniscal pathology).  The left knee ROM following repetitive movement was flexion of 140 and 145 degrees (normal) and extension was 0 degrees (normal).  There was a normal Q angle and patellar tracking.  Anterior drawer, posterior drawer, and Lachman’s testing were stable.  Varus and valgus stress testing were stable at 0 and 30 degrees.  There was no effusion.  

At the C&P examination the CI reported mild to moderate knee pain.  Physical examination showed the left knee ROM following repetitive movement was flexion of 140 and 150 degrees with normal extension) not additionally limited by pain, fatigue, weakness, or lack of endurance.  There were no clinical signs of instability of the knee.  McMurray and drawer signs were negative.  There was no swelling, crepitus or tenderness noted.  X-ray of the knee showed no arthritis.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the knee condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing minimal and intermittent pain according to the US Army Physical Disability Agency pain policy (AR 635-40).  The VA rated the knee condition as not service connected, coded 5261 (leg, limitation of extension), based on the C&P examination, citing no clinically diagnosed disability, permanent residual, or chronic disability.  

There was no evidence of painful motion with functional loss supporting a 10% rating (based on §§4.59, 4.40 and 4.45).  There likewise was no limitation of motion which attained a 10% rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), or history of surgery to remove a meniscus (5259) to support a rating under those codes.  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).  No additional functional limitation was evidenced by the examinations.  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 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.  

BOARD FINDINGS:  In the matter of the chronic lumbar degenerative disc disease, the panel recommends a disability rating of 20%, coded 5243 IAW VASRD §4.71a.  In the matter of the chronic left knee pain 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 the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Lumbar Degenerative Disc Disease	5237	20%	
Chronic Left Knee Pain	5099-5003	0%	
COMBINED	20%	

AR20190008872, 

Dear XXXXXXXXXXXXX

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.