RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxxxxxxXXXXXXXXXXX	CASE:  PD-2017-02726
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080617

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Automated Logistics Specialist, medically separated for “right knee pain,” “multi-level degenerative disc disease with back” and “chronic right dominant wrist pain,” rated 10%, 10% and 0%, respectively, with a combined disability rating of 20%.

CI CONTENTION:  “Review all conditions.”  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 - 20080229	VARD - 20081205	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain	5099-5003	10%	Right Knee Partial Medial Meniscectomy	5010	10%	20080612	
Multi-Level DDD with Back Pain	5237	10%	Intermittent Low Back Strain	5010-5237	10%		
Chronic Right Dominant Wrist Pain	5099-5003	0%	Wrist Pain, Right	5215	NSC		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Right Knee Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent right knee surgeries in 2004 (meniscal repair), 2006 (anterior cruciate ligament reconstruction) and 2007 (contracture release and medial meniscus debridement).  The 11 December 2007 MEB NARSUM examination, 6 months prior to separation, noted complaints of right knee stiffness and pain with prolonged standing.  Physical examination showed a right-sided antalgic gait with knee brace.  Right knee X-rays showed moderate degenerative joint changes.  Repetitive right knee flexion was 120 degrees (normal 140) and extension was 5 degrees (normal 0).  Painful motion and instability were not addressed.

At the 12 June 2008 VA Compensation and Pension (C&P) examination, 1 week before separation, the CI reported right knee pain.  Physical examination showed a normal gait without use of ambulatory devices.  Repetitive right knee flexion was 140 degrees and extension was 0 degrees.  Painful motion was not addressed, but the examiner noted no range of motion (ROM) loss due to pain, fatigue, weakness, lack of endurance or incoordination following repetitive use.  Provocative testing for right knee instability or meniscal pathology was negative. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing mechanical limitation of flexion.  The VA also rated the right knee condition 10%, coded 5010 (arthritis due to trauma), based on the C&P examination, citing constant knee pain with use, knee surgeries and painful motion.  The panel agreed that the MEB NARSUM ROM examination recorded right knee extension to 5 degrees to support a 10% rating under code 5261.  Alternatively, there was a history of right knee cartilage (meniscus) surgery that was symptomatic to support a 10% rating.  There was no limitation of flexion (5260); no evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258); no fracture, nonunion or malunion of the femur or tibia causing a knee impairment (5255, 5262); and no evidence of recurrent subluxation or lateral instability (5257) to support a rating under those codes.  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.  

Multi-Level Degenerative Disc Disease with Back Pain.  According to the STR and MEB NARSUM, the CI’s back condition began in 2000 after heavy lifting.  He denied any other injury.  The 8 January 2008 MEB physical therapy (PT) examination, 5 months before separation, revealed a right antalgic gait due to right knee pain.  There was no spinal tenderness, muscle spasm or guarding.  Goniometric-measured thoracolumbar flexion was 90 degrees (normal) and combined ROM was 240 degrees (normal).  Painful motion was not addressed.  An orthopedic examination on 14 January 2008, 5 months before separation, revealed a normal gait and stance without muscle spasm, but spinal tenderness was present.  Lower extremity sensory and motor strength testing were normal.  Straight leg raise testing for radiculopathy was negative.  Lumbar spine ROM was normal and painful motion was not addressed.  During the 8 February 2008 MEB addendum, 4 months prior to separation, the CI reported chronic low back pain.  Physical examination showed a normal gait with slight lumbar lordosis (curving inward).  There was spinal tenderness but no spasm.  Bilateral lower extremity strength was 5/5 bilaterally, sensation was intact, deep tendon reflexes were normal, and straight leg raise testing was negative.  

At the C&P examination the CI reported constant lower back pain aggravated by physical activity.  Physical examination showed a normal gait and posture, and no spinal tenderness or muscle spasm.  Straight leg test for radiculopathy was negative.  Lumbar flexion was 90 degrees (normal) and combined ROM was 240 degrees (normal).  Painful motion was not addressed.  There was no ROM loss following repetitive use.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5237 (lumbosacral strain), citing spinal tenderness.  The VA also rated the back condition 10%, dual coded 5010-5237 (arthritis, due to trauma-lumbosacral strain), based on the C&P examination, citing painful or limited motion of a group of minor joints.  

Although there was insufficient limitation of motion to support a 10% rating, the panel agreed a 10% rating was justified for the presence of localized spinal tenderness, as reported on the orthopedic and MEB addendum examinations.  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.  The panel also noted there was no objective evidence of a radiculopathy with functional impairments (such as weakness).  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 Dominant Wrist Pain.  According to the STR and MEB NARSUM, the CI’s right wrist condition began in 2002 after playing soccer.  X-rays in 2008 were within normal limits.  The 8 January 2008 MEB PT examination showed right wrist flexion (palmer flexion) of 65 degrees (normal 80), extension (dorsiflexion) of 68 degrees (normal 70), ulnar deviation of 50 degrees (normal 45) and radial deviation of 28 degrees (normal 20).  Painful motion was elicited with flexion, extension and radial and ulnar deviation.  The MEB NARSUM addendum noted complaints of chronic right wrist pain.  Physical examination showed tenderness over the radial volar aspect without evidence of instability.  Tests for carpal tunnel syndrome were negative.  Strength on resistance to flexion and extension was 5/5 and there was no deformity.  Right wrist motion was normal and painful motion was not addressed.  

At the C&P examination the CI reported right wrist aching and occasional pain aggravated by physical activity.  Physical examination showed no right wrist tenderness, guarding of movement, deformity, swelling, instability or locking pain.  Right wrist X-rays were “within normal limits.”  Right wrist ROM testing was “full” without painful motion.  There was no ROM loss due to pain, fatigue, weakness, lack of endurance or incoordination following repetitive use.  There was no right wrist diagnosis rendered as there was no pathology noted.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right wrist condition 0%, analogously coded 5099-5003, citing slight and occasional pain IAW the US Army Physical Disability Agency pain policy.  The VA rated the right wrist condition 0%, coded 5215 (wrist, limitation of motion), based on the C&P examination, citing a noncompensable examination.  The panel agreed there was no limitation of flexion or palmer flexion that supported a rating under the VASRD diagnostic codes for limitation of motion (5214, 5215) or evidence of painful motion with functional loss (IAW VASRD §4.59, 4.40, 4.45) to support a 10% rating.  There was no evidence of atrophy of the muscles in the hand to support a rating under the median or ulnar nerve codes (8515, 8516).  There was no evidence of substantial loss of use of the hand or wrist to support a rating under code 8511 (middle radicular group), or 8512 (lower radicular group).  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 wrist condition.

BOARD FINDINGS:  In the matter of the right knee condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  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 wrist 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.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170308, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20190009146, XXXXXXXXXXXX

Dear XXXXXXXXXXXX:

	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.