RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2017-04814
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090710

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E6, Human Resources Specialist, medically separated for “chronic right knee pain” and “degenerative spondylosis of the lower back,” 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 - 20090519	VARD - 20090911	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5099-5003	10%	Right Iliotibial Band Syndrome 	5299-5260	10%	20090826	
Degenerative Spondylosis of the Lower Back	5299-5242	10%	Lumbar Disc Herniation	5242	10%	20090826	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI reported a history of right knee pain that began in August 2003 after slipping and twisting the knee while running.  An MRI was normal.  The condition worsened in June 2005 after taking the APFT.  The 29 August 2008 MEB NARSUM examination, 11 months prior to separation, noted complaints instability and knee pain.  Physical examination showed no crepitus with flexion; however, a single loud crack occurred at the end of the examination which was reported to occur daily with stairs.  No laxity, patellar apprehension, effusion, redness, swelling, heat or tenderness was noted.  Range of motion (ROM) measurements showed flexion of 126 degrees (normal 140).  The examiner did not note the presence of painful motion.  

At the 26 August 2009 VA Compensation and Pension (C&P) examination, 11 months after separation, the CI reported the pain was controlled with a TENS unit with pain intensity rated 5/10.  Physical examination showed an antalgic gait that was slow and somewhat unsteady.  Lower extremity strength and reflexes were normal.  The ROM study showed flexion of 140 degrees with full extension.  The examiner did not note the presence of painful motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, analogously coded 5003 (arthritis, degenerative), citing satisfactory evidence of painful motion.  The VA also rated the right knee condition 10%, analogously coded 5260 (leg, limitation of flexion), based on the C&P examination, citing painful motion.  There was insufficient limitation of motion to support a 10% rating under the codes for limitation of knee motion (5260, 5261), and no evidence of painful motion.  Although panel deliberations arrived at a 0% rating based on the examinations proximate to separation, the panel may not recommend a lower rating than that of the PEB.  Therefore, no change to the PEB adjudication is recommended.  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.  

Degenerative Spondylosis of the Lower Back.  According to the STR and MEB NARSUM, the CI’s back condition began in August 2003 when the CI slipped and heard a popping sound in the low back.  An EMG in February 2009 showed no abnormalities, but an MRI in March 2009 showed a disc protrusion at L4-L5.  Despite undergoing traction, TENS unit therapy and wearing a sacroiliac belt, the CI continued to have back pain.  The MEB NARSUM examination noted complaints of daily back pain related to activity and some lower back pain with lying down.  Physical examination showed normal lumbar lordosis, heel and toe walk, and neurological examination.  The ROM study showed thoracolumbar flexion of 85 degrees (normal 90) and combined ROM of 235 degrees (normal 240).  There was no weakness, lack of endurance, instability, fatigueability, incoordination or pain with repetition.  At a 19 November 2008 neurology evaluation, 8 months prior to separation, the CI reported pain and right leg pins-and-needles sensation going down the lateral side of her leg to the ankle and pain from the right hip to the knee.  Physical examination showed significant pain and tenderness in the lateral aspect of her right thigh in the iliotibial tract.  There was no weakness of the lower extremities.  

During the C&P examination, the CI reported pain to the back and legs with discomfort rated 2/10.  Physical examination showed an antalgic gait that was slow and unsteady and required the use of a cane, but the straight leg raise test was negative.  The CI had tight paraspinal muscles and tenderness.  The ROM study showed, after repetition, forward flexion of 90 degrees and combined ROM of 225 degrees with pain noted with flexion, extension and right lateral bending.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded as 5242 (degenerative arthritis of the spine), citing spasm and satisfactory evidence of painful motion.  The VA also rated the back condition 10%, coded 5242, based on the C&P examination, citing localized tenderness not resulting in abnormal gait.  The panel agreed that a 10% rating, but no higher, was justified for limitation of combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the MEB NARSUM and C&P examinations.  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.  There was no associated radiculopathy for separate peripheral nerve rating.  While the CI may have experienced radiating pain from the back condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  There was no objective evidence of a radiculopathy with functional impairment (such as weakness) that directly impacted fitness for duty.  There was no evidence in this case that a neurologic abnormality existed to any degree that could be described as functionally impairing.  The panel therefore concluded that additional disability rating was not justified on this basis.  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.  

BOARD FINDINGS:  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 back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  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:

	PD-2017-04814

[AR NUMBER], XXXXXXXXXXXXXXX

Dear XXXXXXXXXXXX

	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.

A copy of this decision has been provided to the counsel you listed on your application, 

Enclosure

	
	PD-2017-04814