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Dear XXXXXXXXXX:

	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.

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX.	CASE:  PD-2017-03455
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070716

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve 03, Air Defense Artillery Officer, medically separated for “degenerative disc disease of the thoracolumbar spine” and “right ACL insufficiency” rated 10% each, with a combined disability rating of 20%.   

CI CONTENTION:  The CI received a higher rating from the VA.  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 - 20070426	VARD - 20070817	
Condition	Code	Rating	Condition	Code	Rating	Exam	
DDD of the TL Spine	5299-5242	10%	Thoracic Spondylosis	5242	10%	20070817	
Right ACL Insufficiency 	5257	10%	Status Post ACL Reconstruction of the Right Knee	5010-5260	10%	20070817	
Neck Pain	Not Unfitting	Cervical Strain	5237	10%	20070817	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Degenerative Disc Disease (DDD) of the Thoracolumbar (TL) Spine.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI was injured by a horse in January 2005 and X-rays showed a thoracic spine vertebral body fracture.  The condition was aggravated during her deployment with wear of body armor.  Thoracic and lumbar spine MRIs in February 2007 showed degenerative changes of the thoracic spine with maintenance of the vertebral body heights and DDD of the lumbar spine.  The 21 December 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, revealed pain with resistance to arm movement.  Back range of motion (ROM) was good.  During the 13 February 2007 MEB NARSUM examination, 5 months prior to separation, the CI complained of upper mid back pain.  Physical examination showed tenderness over the TL spine.  Full ROM was noted in all planes of motion.  The CI was able to toe and heel walk without difficulty.  Strength and reflexes were normal.   

At the 14 March 2007 VA Compensation and Pension (C&P) examination, 4 months before separation, the CI reported constant localized mid-back pain, aggravated by physical activity.  She did not report incapacitation.  Physical examination showed no evidence of radiating pain on movement, muscle spasm or tenderness.  The spine was symmetrical in appearance with normal curvatures.  Thoracolumbar flexion was 90 degrees (normal) and combined ROM was 240 degrees (normal) with pain.  There was no loss of ROM with repetitive use.  The VA examiner noted no signs of intervertebral disc syndrome.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5299-5242 (analogous to degenerative arthritis of the spine), citing full ROM and tenderness.  The VA also rated the back condition 10%, coded 5242, based on the C&P examination, citing painful motion of the spine.

There was no limitation of motion to support a 10% rating under the General Rating Formula for Diseases and Injuries of the Spine.  However, the NARSUM noted tenderness, which supports a 10% spine rating and the VA examination noted painful motion which would also support a 10% rating.  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 Anterior Cruciate Ligament (ACL) Insufficiency.  According to the STR and MEB NARSUM, the CI underwent ACL reconstruction and medial meniscectomy on 28 October 1998.  The ACL reconstruction failed and on 17 September 1999, the CI underwent repeat ACL surgery.  Following the second surgery the CI was unable to return to running due to knee pain.  In September 2006, a repeat arthroscopy showed mild to moderate osteoarthritis with fraying of the ACL and re-tearing of the meniscus.  At orthopedic follow-up visits after surgery in October and November 2006, the knee was noted to be stable.  The 11 January 2007 orthopedic evaluation showed a 1A Lachman’s (ACL injury).  The examiner noted no significant instability but the CI had significant osteoarthritis and chondromalacia.  

During the 21 December 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, physical examination revealed decreased ROM with severe pain when attempting to squat.  Moderate crepitus was present.  The 13 February 2007 MEB NARSUM examination, 5 months prior to separation, noted complaints of 5/10 bilateral knee pain worse with stair climbing, running or prolonged standing.  No instability was reported.  Physical examination revealed mild tenderness over the surgical scars.   Right knee ROM was 5 degrees of hyperextension (normal 0) and flexion of 125 degrees (normal 140).  There was no evidence of varus or valgus instability, with a 1B Lachman’s test on the right (small amount of anterior translation without a firm endpoint).  

At the 14 March 2007 VA Compensation and Pension (C&P) examination, 4 months before separation, the CI reported right knee pain, stiffness, weakness, swelling after exertion, give-way several times per day and lack of endurance.  Physical examination showed no edema, effusion, tenderness, redness, heat, weakness, locking pain, abnormal movement, subluxation or guarding of movement.  Flexion was 140 degrees and extension was 0 degrees, with pain at the end range of flexion.  There was pain but no limitation after repetition.  There was no evidence of instability or meniscal pathology.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5257 (knee other impairment), citing Lachman’s test IAW DoDI 1332.39 E2.A1.1.15.2.3 (now rescinded).  The VA also rated the right knee condition 10%, coded 5257 (knee, other impairment of) based on the C&P examination, citing painful motion.

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).  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 history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to support a rating under that code.  Examinations did not note significant instability or laxity (5257).  There was no fracture, non-union 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 higher than a 10% rating supported under any applicable VASRD code, and no grounds for additional rating based on the presence of instability.  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.  

Contended PEB Condition:  Neck Pain.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  Although the neck condition was profiled and noted to fail retention standards, it was not implicated as duty limiting in the commander’s statement.  In the 2 years prior to separation, the STR contained no treatment visits for neck pain.  The February 2007 MRI showed a normal cervical spine.  There was no performance-based evidence from the record that showed the neck 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 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 neck condition, the panel recommends no change from the PEB determination 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.