RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03252
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090827

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Unit Supply Specialist, medically separated for “lumbar disc bulge” and “right knee patellofemoral pain syndrome,” rated 10% each, 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 - 20090617	VARD - 20090829	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar Disc Bulge	5243	10%	Degenerative Disc Disease, Lumbar Spine	5243	10%	20090401	
Right Knee Patellofemoral Pain Syndrome	5260	10%	Patellofemoral Pain Syndrome and Benign Osteofibroma, Right Knee	5260	10%	20090401	
Right Femur Osteofibroma	Not Unfitting					
PTSD	Not Unfitting	Mood Disorder, NOS	9435	30%	20090331	
Post Concussion Syndrome	Not Unfitting	Posttraumatic Headaches	8045	10%	20090428	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Lumbar Disc Bulge.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition began in October 2008 after heavy lifting.  An MRI showed a “small central disc protrusion at L5-S1.”  This case was adjudicated as part of the Pilot Disability Evaluation System under the Policy and Procedure Directive-Type Memorandum of 21 November 2007.  The 28 May 2009 MEB NARSUM examination referred to the following VA examination.  At the 1 April 2009 VA Compensation and Pension (C&P) examination, 3 months before separation, the CI reported progressively worse low back pain.  Physical examination showed a normal gait without guarding, spasm or tenderness.  Range of motion (ROM) testing showed flexion of 80 degrees (normal 90) and combined ROM of 200 degrees (normal 240) with painful motion, but no further limitation with repetition.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5243 (intervertebral disc syndrome), based on the VA rating decision.  The VA rated the back condition 10%, coded 5243, based on the C&P examination, citing limitation of motion.  The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion greater than 60 degrees but not greater than 85 degrees, as reported on 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 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.  

Right Knee Patellofemoral Pain Syndrome.  According to the STR and MEB NARSUM, the CI’s right knee condition began in 2006 while running.  Radiographic studies in September 2007 showed a benign radiolucency “most likely representing a non-ossifying fibroma,” but were otherwise normal.  An MRI in December 2008 showed no internal derangement of the right knee.

At the 1 April 2009 VA C&P examination, 3 months before separation, the examination showed a normal gait without swelling, effusion, tenderness or laxity.  The ROM evaluation showed flexion of 120 degrees (normal 140) and extension of 0 degrees (normal) with painful motion, but no further limitation with repetition.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5260 (limitation of leg flexion), based on the VA rating decision.  The VA rated the right knee condition 10%, coded 5260, based on the C&P examination, citing painful motion of a major joint.  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), 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).  There was therefore no VASRD §4.71a rating higher than the 10% adjudicated by the PEB under any applicable code.  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 right knee condition.  

Contended PEB Conditions:  Right Femur Osteofibroma, PTSD and Post Concussion Syndrome.  The panel’s main charge is to assess the fairness of the PEB determinations that the contended conditions were not unfitting.  None of the conditions were profiled, implicated in the commander’s statement or judged to fail retention standards.  The neuropsychological report noted that the CI had experienced some difficulties with tasks of processing speed, visual scanning/attention, and list learning tasks, but not so severe as to impair his ability to perform his duties.  The examiner also noted the CI’s mental health condition did not meet criteria for PTSD or any other anxiety or depressive disorder.  There was no performance-based evidence from the record that any of the conditions 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 any of the contended conditions, so no additional disability ratings are recommended.  

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.  In the matter of the contended right femur osteofibroma, PTSD and post-concussion syndrome, 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.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

AR20180015323, 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.

Enclosure