RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01973
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071208

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Water Treatment Specialist, medically separated for “cervical spondylosis” and “left patellofemoral pain syndrome,” rated 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 - 20070912	VARD - 20080421	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Cervical Spondylosis	5237	10%	Cervical Spondylosis	5299-5239	10%	20070712	
Left Patellofemoral Pain Syndrome	5099-5003	10%	Left Knee Posterior Horn Lateral Meniscus Tear and Debridement with Chondromalacia	5299-5014	10%	20070712	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Cervical Spondylosis.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s neck condition began in November 2006 when he noted onset of neck discomfort marked by popping and grating sensations with certain movements and without any reports of injury or trauma.  Cervical spine X-rays on 8 March 2007 were normal other than very minimal encroachment of the right neural foramina at C6-C7 and C7-T1.  A 9 May 2007 CT scan showed cervical spondylosis with bone spurs projecting into the neural foramen bilaterally, more so on the left, and disc space narrowing at C3-4.  The 6 July 2007 MEB NARSUM examination, 5 months prior to separation, noted complaints of occasional slight-to-moderate neck pain aggravated by lifting heavy objects and wearing a Kevlar helmet.  Physical examination showed a normal gait with cervical spine tenderness between the left shoulder blade and upper thoracic spine.  The examiner referred to the VA Compensation and Pension (C&P) examination for range of motion (ROM) measurements.

At the 6 July 2007 VA C&P examination, also 5 months before separation, the CI reported a popping and grating sensation in his neck upon certain movements sometimes associated with headaches and soreness and heat in the occiput.  He denied arm pain and numbness, but did note some hypersensitivity on volar aspect on the left hand.  Physical examination showed a normal gait and normal-appearing neck, with tenderness but no spasms and full muscle strength.  ROM showed flexion of 40 degrees (normal 45) and combined ROM of 255 (normal 340) after repetition, with painful motion.  There was no change in motion with repetition.  The 24 August 2007 physical therapy (PT) ROM measurements, which were performed with an inclinometer except for rotation, which was measured with a goniometer, showed flexion of 60 degrees and combined ROM of 290 degrees, with painful motion reported.  Gait and spinal contour were normal.  There was tenderness, but no muscle spasm.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 10%, coded 5237 (cervical strain), citing limited and painful motion and localized tenderness without spasm.  The VA also rated the neck condition 10%, analogously coded 5299-5239 (spondylolisthesis or segmental instability), based on the C&P examination, citing loss of range of motion.  The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 40 degrees), as reported on the C&P examination.  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 (IVDS) 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 neck condition.  

Left Patellofemoral Pain Syndrome.  According to the STR and MEB NARSUM, the CI had an injury to the left knee in 1995 when playing basketball and underwent arthroscopic surgery with debridement of a lateral meniscal tear in October 2001, during a previous period of active duty.  In April 2005, the CI complained of left knee pain after running and was referred for physical therapy in October 2005.  At an orthopedic clinic visit on 22 March 2006 the CI reported left knee pain.  X-rays demonstrated joint line irregularity and narrowing on the left, and an MRI showed chondral changes and meniscal changes with a questionable anterior cruciate ligament and an intact posterior cruciate ligament.  The examiner noted there was moderate arthrosis of the left knee that was non-surgical.  A P2 profile was issued since the CI was able to do his job.  

At an orthopedic clinic appointment on 18 April 2007, the CI reported left anterior knee pain for 12 years, with current difficulty running and long walking.  Physical examination showed the patellofemoral region was tender but there was no effusion, instability or evidence of a torn meniscus.  Crepitus (grinding sensation) was present and the ROM of both knees was normal.  X-rays revealed arthritic changes in the patellofemoral and medial knee joint.  X-rays of the left knee dated 18 April 2007 demonstrated no acute pathology, tricompartmental osteoarthritis or patellar enthesopathy (bony projections at the attachment of a tendon or ligament).  The MEB NARSUM examination noted complaints of constant slight to moderate left knee pain aggravated by weather changes, squatting, running more than a mile and climbing stairs.  Physical examination showed a normal gait with left knee tenderness over the anterolateral patella and over the lateral joint space.  Lachman’s test (to determine laxity) was negative.  The ROM was full with painful motion starting at 100 degrees of flexion.  
At the C&P examination, the CI reported dull anterior pain and weakness in the left knee, with the same aggravating factors reported on the NARSUM.  Physical examination showed a normal gait.  There was tenderness and significant patellar crepitus.  ROM was flexion of 110 degrees (normal 140) and extension of 0 degrees (normal), with painful motion.  There was no change in motion with repetition.  Lachman’s, McMurray’s (to determine a meniscal tear), and drawer (to determine laxity) tests were negative; varus testing (to determine lateral instability) was reported as positive and valgus testing (to determine medial instability) as negative.  Physical therapy ROM measurements on 24 August 2007 showed flexion of 125 degrees and extension of 0 degrees with painful motion reported.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing knee pain limited the ability to perform most Army functional activities.  The VA also rated the left knee condition 10%, analogously coded 5299-5014 (osteomalacia), based on the C&P examination, continuing a rating assigned prior to the current tour of active duty.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  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.  The 5259 code (cartilage, semilunar, removal of, symptomatic) was applicable in this case but the maximum 10% rating under that code provided no benefit to the CI.  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).  There was therefore no VASRD §4.71a rating option higher than the 10% adjudicated by the PEB under any applicable code.  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 neck condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the left 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.  

AR20180011267, 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.