RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXX	CASE: PD-2017-02743
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20070819

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Human Resource Specialist, medically separated for “herniated nucleus pulposus [HNP] C5-6 and C6-7 along with degenerative disc disease [DDD],” “lumbar DDD,” and “chondromalacia left knee,” rated 10%, 0% and 0%, respectively, with a combined disability rating of 10%.

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 – 20070621	VARD - 20071015	
Condition	Code	Rating	Condition	Code	Rating	Exam	
C5-6 and C6-7 HNP
with DDD	5243	10%	DDD with HNP of the Cervical Spine	5242-5243	10%	20070723	
Lumbar DDD	5299-5242	0%	DDD of Lumbar Spine	5242-5243	20%	20070723	
Chondromalacia Left Knee	5099-5003	0%	Chondromalacia with Patellofemoral Syndrome of the Left Knee	5099-5024	10%	20070723	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 50%	
	
ANALYSIS SUMMARY:

Cervical HNP with DDD. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s experienced the onset of cervical discomfort and spasm in 2002 after physical training, sit-ups and strenuous activities. Nonsteroidal anti-inflammatory drug and conservative treatment helped resolve symptoms, which never prevented full duty performance.

The 1 June 2007 MEB NARSUM examination, 2 months prior to separation, noted CI complaints of neck pain. Physical examination revealed cervical spine tenderness and paravertebral spasm. Cervical range of motion (ROM) measured by physical therapy (PT) for the MEB on 15 June 2007 revealed flexion of 35 degrees (normal 45) and combined ROM of 250 degrees (normal 340).

At the 23 July 2007 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported neck pain. Physical examination revealed no evidence of muscle spasm, tenderness or ankylosis. Measured ROM revealed normal flexion with combined ROM of 315 degrees (normal 340).  Pain was noted on motion and with repetitive use.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the neck condition 10%, analogously coded 5243 (intervertebral disc syndrome (IVDS)), citing ROM limited by pain. The VA also rated the neck condition 10%, but dual coded 5242-5243 (degenerative arthritis of the spine-IVDS) based on the C&P examination. Panel members agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 40 degrees) or combined ROM (greater than 170 degrees but not greater than 335 degrees), as reported on the MEB and VA 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. 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.

Lumbar DDD. According to the STR and MEB NARSUM, the CI’s low back condition began around 2000-2001. The MEB NARSUM examination noted complaints of low back pain, and physical findings revealed lumbar tenderness. The MEB PT ROM measurements revealed flexion of 20 degrees (normal 90) and combined ROM of 115 degrees (normal 240), with pain. At the VA C&P examination, the CI reported low back pain elicited by physical activity, and the examiner noted thoracolumbar spine tenderness with flexion to 60 degrees and combined ROM of 210 degrees, with painful motion.  Gait and posture were within normal limits.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the low back condition 0%, analogously coded 5299-5242, citing no evidence of spasm or tenderness. The VA rated the low back condition 20%, analogously coded 5242-5243, citing thoracolumbar ROM criteria. Panel members noted that while the MEB PT ROM measurements met criteria for a 40% rating, higher probative value was placed on the VA examination based on its proximity to separation and use of VASRD compliant goniometer ROM measurements. Thus, 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 or combined ROM not greater than 120 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 low back condition, coded 5242.

Left Knee Pain. According to the STR and MEB NARSUM, the CI’s knee condition began in 2001 during the course of normal PT and physical activities, with some pain and swelling in the posterior knee. The MEB NARSUM examination noted complaints of left knee pain, and the examiner documented tenderness, a slight posterior bulge and hyperextension, but minimal anterior discomfort leg knee.  The MEB PT ROM study revealed flexion of 135 degrees   (normal
140) and extension to 0 degrees (normal), with pain on movement. At the VA C&P examination the CI reported left knee pain. Physical examination revealed tenderness, normal left knee flexion with pain at full flexion, and normal extension.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left knee condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing no limitation of motion (based on passive ROM to 143 degrees). The VA rated the left knee condition 10%, analogously coded 5099-5024 (tenosynovitis), based on the C&P examination,

citing painful left knee motion. Panel member agreed that a 10% rating for painful motion with functional loss (based on §4.59, §4.40 and §4.45) was warranted. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the left knee condition, coded 5003.

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 low back condition, the panel recommends a disability rating of 20%, coded 5242 IAW VASRD §4.71a. In the matter of the left knee condition, the panel recommends a disability rating of 10%, coded 5003 IAW VASRD
§4.59.

The panel recommends the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Herniated Nucleus Pulposus C5-6 and C6-7 with Degenerative Disc Disease	5243	10%	
Lumbar Degenerative Disc Disease	5299 5242	20%	
Chondromalacia Left Knee	5099 5003	10%	
	COMBINED	40%	

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20170326, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

		PD-2017-02743
AR20190012371, XXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXX

	I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to recharacterize your separation as a permanent disability retirement with the combined disability rating of 40% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The recharacterization of your separation as a permanent disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), XXXXXXXXXXXXXXXXXXXXXXXXXXXX.

	A copy of this decision has also been provided to the Department of Veterans Affairs.

	PD-2017-02743