RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:
BRANCH OF SERVICE: ARMY

CASE: PD-2017-04346 SEPARATION DATE: 20060713

SUM M ARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (Cl) was an active dut y E4, Unit Su pp ly Sp ecialist, medically separated for " low back pain" and "bilat eral knee pain," rated 10% and 0%, respecti vely, with a combined disability rating of 10%.

Cl CONTENTION: Review all conditions.  The complete submission  is at Exhib it A.

SCOPE OF REVIEW: The panel' sscope of review is defined in DoDI 6040.44. It is limit ed to review of disability ratings assigned to those conditions det ermined by the Physical Evaluation Board (PEB) to be unfitting for continued military service, and when speci fi call y request ed by the Cl, those condition s identified by the Medical Evaluation Board (M EB), but determined by the PEB to be not unfitting or non-compensable. Any conditio ns outside the panel' s defined scope of review, and any contention not request ed in thi s app licat ion, may remain eligible for future consideration by the Board for Correc t ion of M ilit ary Reco rds. The panel' s authority is limited to assessing the fai rnessand accuracy of PEB rati ng determinations and recommending correct ions whe n appropriate. The panel gives consideration to VA evidence, part icularly withi n 12 months of separation , but only to the extent that it reasonab ly reflects the severit y of disabi lity at the time of separation.

RATINGCOM PARISON:

SERVICE PEB • 20060607	VARD - 20070328	
Condition	Code	Ratinl!	Condition	Code	Ratinl!	Exam	
Low Back Pain	5237	10%	DDD wi th Bulging Disc at L4-5	5242	20%	
20070306	
Bilateral Knee Pain	5099-5003	0%	Patellofe moral 5vndrome Right Knee	5014-5260	10%		
			Patellofe moral 5vndrome Left Knee	5299-526 1	0%		
COMBINED RATING: 10%		COMBINED RATING OF ALL VA CONDITIONS: 40%		

ANALYSISSUMMARY:

Low Back Pain. According to the service treatment record (STR) and MEB narrat ive summary (NARSUM), the Cl's back condition began in September 2005 while deployed without injury or trauma. An M RI in March 2006 showed mild degenerative disk disease (DDD) with a bulging disc at L4-LS and disc protrusion at LS-Sl. The 24 March 2006 primary care examination showed full painless ra nge of motion (ROM) of the th oracolumba r spine. The 9 May 2006 MEB NARSUM examination, 2 months prior to separation, noted complaints of lower back pain. The ROM examination showe d thoraco lumbar flexion of 90 degrees (norma l) and combined ROM of 240 degrees (norma l) with pain on motion.

At the 6 March 2007 VA Com pe nsation and Pension (C&P) examination, 8 mont hs after separation, the Cl reported low back pain. Physical examination revealed a normal curvature of the spine, but there was spinal tenderness. The ROM stud y revealed forward flexion of 70 degrees and combined ROM of 200 degrees with painfu l mo tion .

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the back condition 10%, analogously coded 5237 (lumbosacral strain), citing tenderness. The VA rated the back condition 20%, analogously coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing criteria for a 10% rating. The VA awarded an additional 10% for increased pain after repetitive motion to fully reflect the functional impairment of the back. 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.

Bilateral Knee Pain. According to the STR and MEB NARSUM, the CI’s bilateral knee condition began in April 2004 without injury or trauma. The pain worsened throughout her deployment and she could no longer function in her MOS. Radiographic studies of the bilateral knees in August 2004 and March 2006 were normal. The MEB NARSUM examination noted complaints of bilateral knee pain. Physical examination revealed full active bilateral knee ROM with pain on the right. The right knee was very painful with any type of patellar compression. There was no effusion, swelling or joint line tenderness and ligament stability was good. McMurray test was negative.

At the C&P examination the CI reported bilateral knee pain that increased when walking down stairs or climbing up an incline. Physical examination of the left knee revealed no pain or crepitus, and ROM testing was normal. Physical examination of right knee revealed a great amount of crepitus along with cracking and popping. Right knee ROM testing revealed normal extension but only 80 degrees of flexion (normal 140) with a significant amount of pain and discomfort.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the bilateral knee condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing full ROM. The VA rated the right knee 10%, coded 5260 (limitation of leg flexion), and the left knee 0%, coded 5261 (limitation of leg extension), based on the C&P examination. Panel members first considered whether the right and left knees, having been de-coupled from the combined PEB adjudication, remained separately unfitting. In this case, both knees failed retention standards. Although notes in the STR indicate the right knee was worse than the left knee, undue speculation would be required to conclude that impairment from either knee would not have unacceptably interfered with duty performance. Therefore, the panel agreed that each knee was reasonably justified as separately unfitting.

There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261) of either knee. However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) for the right knee based on the MEB and VA examinations. The panel considered other knee and analogous codes, but all were less applicable or not advantageous to rating for either knee. Therefore there were no higher ratings than 10% for right knee and 0% for the left knee supported under any applicable code. After due deliberation, considering all the evidence and mindful of VASRD
§4.3 (reasonable doubt), the panel recommends a disability rating as follows: an unfitting right knee, rated 10% and an unfitting left knee rated 0%, both coded 5099-5003.

BOARD FINDINGS: In t h e matter of the back condit ion and IAW VASRD §4.71a, t he panel recommends no change in the PEB adjudication. In the matter of the bilat eral knee condition, the panel recommends an unfitting right knee condition, rat ed 10% and an unfitting left knee condition rated 0%,bot h coded 5099-5003. There are no other conditions within the panel' sscope of review for consideration.

The panel recommendsthe Cl' s prio r determinat ion be modified as fo llow s, effective the date of medical separat ion:

CONDITION	VASRDCODE	PERMANENT RATING	
Low Back Pain	5237	10%	
Right Knee Pain	5099-5003	10%	
Left Knee Pain	5099-5003	0%	
	COMBINED	20%	

The following document ary evidence was considered:

SAMR-RB

DEPARTMENT OF THE ARMY
ARMY REVIEW BOARDS AGENCY 251 18TH STREET SOUTH, SUITE 385
ARLINGTON, VA 22202-3531

MEMORANDUM FOR Commander, US Army Physical Disability Agency (AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for	AR20200004539 (PD-2017-
04346)

1.	I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual. Under the authority of Title 10, United States Code, section 1554a, accept the Board’s recommendation to modify the individual’s disability rating to 20% without re-characterization of the individual’s separation. This decision is final.

2.	I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.

3.	I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY: