RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01647
BRANCH OF SERVICE:  army	SEPARATION DATE:  20050708

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E4, Human Resources Specialist, medically separated for “chronic low back pain” and “chronic right anterior knee pain,” rated 10% and 0%, respectively, with a combined disability rating of 10%.  

CI CONTENTION:  “Recently sent personal doctor MRI, which were not completed by the VA, showing decreased conditions and denied anything above current ratings.”  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 - 20050614	VARD – 20060222 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5237	10%	Residuals Low Back Injury	5010-5243	20%	20051129	
Chronic Right Anterior Knee Pain	5099-5003	0%	Residuals Right Knee Injury	5010-5260	10%	20051129	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Chronic Low Back Pain.  According to the MEB Narrative Summary (NARSUM) and service treatment record (STR), the CI’s back condition was initially treated in November 2004 without noted injury or trauma.  Lumbosacral X-rays were normal, but an MRI found multi-level lumbar spine spondylotic disease and bulging discs, but surgery was not recommended. 

At the 7 January 2005 MEB Special Care examination, 6 months before separation, the CI reported chronic low back pain occasionally radiating to the right buttock to the right knee.  Physical examination revealed a “straight back” (abnormal contour) and no spinal tenderness.  Low back flexion was approximately 45-60 degrees “fingertips to the knees” (normal 90).  Combined range of motion (ROM) could not be quantified, but lateral flexion and rotation were intact and extension was 20 degrees (normal 30).  Painful motion was present.  

The 14 April 2005 MEB NARSUM examination, 3 months before separation, recorded low back pain.  Physical examination revealed a normal spinal contour, but tenderness was present.  The 21 April 2005 physical therapy (PT) ROM study showed flexion of 75 degrees and combined ROM of 180 degrees.  

During the 29 November 2005 VA Compensation and Pension (C&P) joints examination, 5 months after separation, the CI reported daily-constant back pain that intermittently increased in intensity and radiated into the buttocks.  The CI denied numbness, weakness, bowel or bladder complaints or incapacitating episodes within the last 12 months.  Physical examination revealed a normal gait, but there was tenderness.  Lumbar spine flexion was 90 degrees and combined ROM was 230 degrees.  Painful motion was present.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5299-5237 (lumbosacral strain), citing spinal tenderness.  The VA rated the back condition 20%, analogously coded 5010-5243 (arthritis, due to trauma-intervertebral disc syndrome) based on the C&P joint examination, citing limitation of combined motion.  

The panel agreed that a 10% rating, but no higher, was justified for tenderness as reported on the MEB, NARSUM and VA examinations, or limitation of flexion (greater than 60 degrees but not greater than 85 degrees) as reported on the PT examination, and/or combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the PT and VA examinations.  Although the MEB Special Care examination may have supported the next higher 20% rating for flexion, it was more remote from separation and did not provide ROM degree measurements.  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 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.

Chronic Right Knee Pain.  According to the MEB NARSUM and STR, the CI’s right knee condition began in October 2004 after a twisting injury.  Right knee X-rays were normal and surgery was not a consideration.  At the MEB Special Care examination the CI reported occasional right knee popping and numbness.  Physical examination revealed right knee joint line tenderness, a 1A Lachman (slight laxity) and pain with compression of the patellar tendon.  ROM testing showed 0-140 degrees (normal).  Painful motion was not addressed.  

During the MEB NARSUM examination the CI reported right knee pain.  Physical examination revealed right knee tenderness and a positive patellar grind test, but meniscal testing was negative and there was no laxity or instability.  The PT ROM study showed flexion of 135 degrees and extension of 0 degrees with no indication of painful motion.  

At the 29 November 2005 C&P general examination the CI reported dull right knee pain aggravated by running.  Physical examination revealed right knee flexion to 130 degrees and extension to -8 degrees.  Painful motion was not addressed.  During the 29 November 2005 C&P joints examination the CI reported intermittent right knee pain and occasional swelling.  He could not run, squat or go up and down stairs without experiencing pain and swelling.  There were no additional limitations due to repetition or with flare-ups.  Physical examination revealed right knee flexion of 140 degrees and extension of 0 degrees.  Painful motion was absent.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, analogously coded 5099-5003 (arthritis, degenerative), citing “rated at 0% for pain.”  The VA rated the right knee condition 10%, dual coded 5010-5260 (arthritis, due to trauma-leg, limitation of flexion), based on the C&P examination, citing limited or painful motion.  

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 not sufficient 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 right knee condition.

BOARD FINDINGS:  In the matter of the back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  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.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.

AR20180015080, 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.