RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03197
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071110

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E4, Watercraft Engineer, medically separated for “lumbosacral strain” and “arthritis, due to trauma [right knee],” rated 10% and 0%, respectively, with a combined disability rating of 10%. 

CI CONTENTION:  In addition to the right knee, he requested review of the not unfitting left knee and additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20070910	VARD - 20080128	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbosacral Strain	5237	10%	Lumbosacral…Strain	5237	10%	20071102	
Arthritis…Right Knee	5010	0%	Right Knee Osteoarthritis…	5260-5010	10%		
Chronic Left Knee Pain	Not Unfitting 	Left Knee Retropatellar Pain Syndrome and Osteoarthritis	5020	NSC		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Lumbosacral Strain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back pain began in June 2006 after falling.  He had chronic low back since that time and attempted chiropractic care without relief.  During the 23 March 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 8 months prior to separation, physical examination revealed slight tenderness of the back with no muscle spasm.  Range of motion (ROM) was recorded as “full” and painful motion was not addressed.  The 11 April 2007 MEB orthopedic consultation, 7 months before separation, revealed lower back tenderness and pain in all planes of motion; ROM was not recorded.  The 20 June 2007 MEB NARSUM examination did not include a back evaluation but cited the 23 March MEB examination.  

At the 2 November 2007 VA Compensation and Pension (C&P) examination, 8 days prior to separation, the CI complained of constant back pain, rated at 8/10, which travelled up and down his back.  Physical examination showed normal posture and gait, and no tenderness, muscle spasm or radiating pain on movement.  Flexion was to 90 degrees (normal) with a combined ROM of 240 degrees (normal), and pain noted at the limits of motion.

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 the presence of tenderness on examination.  The VA also rated the back condition at 10%, coded 5237 based on the C&P examination, citing pain at the endpoints of motion and functional limitations due to back pain. Members agreed that a 10% rating, but no higher, was justified for the presence of tenderness at the MEB examination and painful motion at the VA 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 also no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula.  After due deliberation, considering all of 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 lumbosacral strain condition.

Right Knee Arthritis.  According to the STR and MEB NARSUM, the CI underwent right knee surgery in August 2005 for an osteochondral defect.  During the MEB examination, 8 months prior to separation, physical examination revealed slight knee tenderness as well as ligamentous laxity (positive anterior drawer test).  Measured ROM was recorded as “full,” but painful motion was not addressed.  The 11 April 2007 MEB orthopedic consultation revealed a small effusion with tenderness, but no erythema, and testing for ligamentous laxity and meniscal damage was negative.   Flexion was to 120 degrees and extension to 0 degrees; painful motion not addressed.  At the 23 May 2007 MEB orthopedic evaluation, 6 months before separation, the CI reported pain with weight bearing activities.  Physical examination showed some mild tenderness medially at the joint line and femoral condyle, but no instability or muscle bulk/tone abnormalities.  Measured ROM showed flexion to 120 degrees and extension to 0 degrees.  The 20 June 2007 MEB NARSUM examination cited the 11 April orthopedic consultation findings.  

At the 2 November 2007 C&P examination, 8 days prior to separation, the CI complained of right knee pain, rated at 8/10, along with weakness and stiffness.  Physical examination showed normal posture and gait; ROM testing showed flexion to 130 degrees and extension to 0 degrees, with pain noted at the limit of flexion.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, coded 5010 (arthritis due to trauma).  The VA rated the right knee 10%, dual coded 5260-5010 (limitation of leg flexion-arthritis due to trauma) based on the C&P examination, citing flexion limited by pain.  Panel members agreed that there was no limitation of flexion or extension that supported ratings under codes 5260 or 5261; or history/evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions to support a rating under code 5258.  Additionally, 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, however, evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right knee condition, coded 5099-5003.  

Contended PEB Condition:  Chronic Left Knee Pain.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  While mentioned in the commander’s statement, the contended condition was not profiled and was judged to not fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the lumbosacral strain condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the arthritis due to trauma (of the right knee), the panel recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  In the matter of the contended left knee condition, the panel recommends no change from the PEB determinations as not unfitting.  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	
Lumbosacral Strain	5237	10%	
Arthritis Due to Trauma (of the Right Knee)	5099-5003	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170409, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180009595, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

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.

Sincerely,					      
Enclosure