RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04937
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090120

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Multi-channel Transmission Operator/Maintainer, medically separated for “intervertebral disc syndrome” and “right knee chondromalacia,” 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 - 20081222	VARD - 20130509	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Intervertebral Disc Syndrome	5243	10%	Degenerative Disk Disease , L5-S1 Spine	5243	0%	20081024	
Right Knee Chondromalacia	5099-5003	10%	Right Knee Internal Derangement, Partial Tear Of ACL	5257	0%		
Left Knee Chondromalacia	Not Unfitting	Left Knee Meniscal Degeneration	5257	0%		
Hemorrhoids		Hemorrhoids	7336	NSC		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Intervertebral Disc Syndrome (IVDS).  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI experienced back pain in November 2006 after heavy lifting.  An MRI in March 2008 showed left disc herniation of L5-S1 with foraminal encroachment, but he was determined to not be a surgical candidate by orthopedics.  The 7 October 2008 physical therapy thoracolumbar range of motion (ROM) measurements were normal except for limitation of flexion to 85 degrees (normal 90).  There was pain in all planes of motion.

The 20 October 2008 MEB NARSUM examination, 3 months prior to separation, noted CI complaints of low back pain rated at 4-5/10 while at rest, and increased to 7/10 with lifting, prolonged standing, and walking.  There was sleep disturbance secondary to back pain and he also reported left posterior thigh numbness and tingling.  Physical examination showed significant lumbar tenderness without muscle spasms.  The ROM was normal; however, there was pain in most planes of motion.  Radicular testing was negative.  

At the VA Compensation and Pension (C&P) examination on the same day, the CI reported lower back pain radiating into the left leg, with numbness, and rated at 8/10 about 4 times per week for a duration of 45 minutes.  Physical examination showed normal gait and ROM, and no tenderness or muscle spasm.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5243 (IVDS), citing painful motion and limitation of flexion to 85 degrees.  The VA rated the low back condition 0%, also coded 5243, based on the C&P examination, citing ROM within normal limits.  Members agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) and painful motion, as reported on the NARSUM 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 incapacitating episodes secondary to IVDS 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 lower back pain condition.  

Right Knee Chondromalacia.  According to the STR and MEB NARSUM, the CI’s right knee pain began in May 2007 after an injury playing softball.  An August 2007 MRI showed patellar chondromalacia of the right knee and a possible anterior cruciate ligament tear. There was no left knee ligament or meniscal pathology.  A 17 September 2008 orthopedic evaluation noted complaints of right knee pain, and the provider recorded patellofemoral joint tenderness, patellar grind, no instability, and full ROM.

During the MEB NARSUM examination, the CI described right knee pain rated at 2-3/10 at rest, and 6/10 with prolonged standing, walking and running.  Physical examination showed an “altered gait from right knee pain,” tenderness over the patellofemoral region, and positive patellar grind.  The CI also had mild left knee pain, and flexion elicited painful motion bilaterally.   

At the C&P examination, the CI reported bilateral knee pain which flared to 7/10 about 4 times a week for 45 minutes.  Physical examination showed normal knees without tenderness or painful or limited motion or ROM.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing painful motion.  The VA rated the right knee condition 0%, coded 5257 (knee, other impairment of), based on the C&P examination, citing no compensable symptoms.  Members noted there was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261). However, the NARSUM examination evidenced 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); and 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 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:  Hemorrhoids and Left Knee Chondromalacia.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  The contended hemorrhoid condition was not profiled or implicated in the commander’s statement, and did not to fail retention standards.  There was no performance-based evidence from the record that either 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 lower back and right knee conditions and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended hemorrhoid and left knee conditions, 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.  

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.

Sincerely,					       

Enclosure