RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXX	CASE: PD-2019-04156
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20070827

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Cannon Crewmember, medically separated for “lumbar degenerative disc disease (DDD)” rated at 10% and “left knee chondromalacia patella” rated at 0%, 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 - 20070803	VARD - 20071206	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar DDD	5299-5242	10%	Lumbar Spine DDD with Diffuse Disk Bulge	5242	10%	20071011	
Left Knee Chondromalacia Patella	
5099-5003	
0%	Left Knee Mild Anterior Laxity	5257	10%	20071011	
			Left Knee Chondromalacia Patella	5299-5260	10%	20071011	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:

Lumbar DDD. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s low back condition began during a deployment in November 2006 when he was lifting heavy equipment. Radiographic studies noted diffuse disc bulging of L4 to S1 vertebral levels.  On 12 July 2007, physical therapy (PT) measured spinal range of motion (ROM) that was

painful but near normal citing forward flexion to 85 degrees (normal 90) with normal combined ROM. At the 13 July 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), one month prior to separation, the physical examination (PE) noted “full ROM” of the spine. Tenderness was present about spinal level L4 without spasms or guarding. His gait was normal. The 23 July 2007 MEB NARSUM examination, one month prior to separation, noted complaints of inability to lift and carry heavy loads. The CI reported constant low back pain. He endorsed the inability to run or walk/stand for extended periods. The PE remained unchanged from the MEB examination conducted 10 days prior on 13 July 2007.

At the 11 October 2007 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported back pain with lifting over 70 pounds. The PE revealed lumbar tenderness. Spinal ROM was painful but normal. There was no loss in motion due to pain, fatigue, weakness or incoordination.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the lumbar DDD condition 10%, analogously coded 5299-5242 (degenerative arthritis), citing forward flexion 85 degrees with combined 240 degrees. Utilizing the same primary code, the VA also rated the spinal condition at 10% based on the C&P examination, citing spinal tenderness and loss of ROM. Panel members agreed that a 10% rating, but no higher, was justified for either the presence of painful spinal motion or local spinal tenderness as seen in examinations within 2 months either side of separation. 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 lumbar DDD condition.

Left Knee Chondromalacia Patella. According to the STR and MEB NARSUM, the CI obtained a physical waiver for enlistment in 2004 due to prior surgical intervention to his left knee. Without any direct trauma, the CI’s left knee began to be painfully symptomatic in early 2005. An MRI of was reported as “unremarkable” and the CI was rendered a diagnosis of osteoarthritis of the left knee. His treatment remained conservative to include PT and activity restrictions. The PT ROM examination on 12 July 2007 noted left knee flexion to 120 degrees (normal 140) with pain. Extension was normal. At the orthopedic examination dated 31 May 2007, 3 months prior to separation, the knee-focused PE was normal. The 23 July 2007 MEB NARSUM examination, noted complaints of constant left knee pain. The PE findings were noted to include full ROM of the left knee.  Local tenderness was present.

At the 11 October 2007 VA Compensation and Pension (C&P) examination, the CI reported continued pain in the left knee. The PE revealed local tenderness about the left knee. There was mild anterior joint laxity, but no medial or lateral laxity. There was no joint effusion. ROM noted normal extension and flexion to 110 degrees with no additional loss due to pain, fatigue, weakness, or incoordination.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left knee chondromalacia patella condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing ROM limited by pain and noting that the condition existed prior to service and was permanently service-aggravated. The VA rated the left knee mild anterior laxity condition 10%, coded 5257 (knee, other impairment) as well as the left knee chondromalacia patella condition 10%, analogously coded 5299-5260 (leg, limitation of flexion) based on the C&P examination, citing mild anterior laxity of the left knee and slight limited and painful motion, respectively. Panel members agreed that 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), to support a rating under that code. 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 10%. The panel additionally considered if there was joint laxity significant enough to warrant an additional rating. Panel members debated the significance of the C&P examination’s minimally positive laxity test while other examinations did not detail any such finding. The panel concluded that there was insufficient evidence of ligament instability to support a dual coding scheme under 5003 and 5257. 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 chondromalacia condition, analogously coded 5299-5003.

BOARD FINDINGS: In the matter of the lumbar degenerative disc disease and IAW VASRD §4.71 the panel recommends no change in the PEB adjudication. In the matter of the left knee chondromalacia patella condition, the panel recommends a disability rating of 10%, analogously coded 5099-5003 IAW VASRD §4.71a. 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	
Lumbar Degenerative Disc Disease	5299-5242	10%	
Left Knee Chondromalacia Patella	5099-5003	10%	
	COMBINED	20%	

The following documentary evidence was considered:

	PD-2019-04156

AR20190011745, XXXXXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXXXXX

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 

	PD-2019-04156