RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX  	CASE:  PD-2017-04945
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050909

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E5, Chemical Operations Specialist, medically separated for “lumbosacral strain” and “chronic bilateral knee pain,” rated 10% each, with a combined disability rating of 20%.   

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 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 - 20050819	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbosacral Strain	5237	10%	No VA Examination in Evidence 	
Chronic Bilateral Knee Pain	5099-5003	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Lumbosacral Strain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI developed persistent low back pain after a fall in November 2004.  Serial X-rays demonstrated only mild degenerative changes.  Multiple neurological examinations were normal and surgery was not indicated.  Multiple provider entries in the STR documented grossly normal range of motion (ROM) with no contrary entries.  There was ample STR documentation of a normal gait and normal spinal contour.

The 10 June 2005 MEB NARSUM examination, 3 months prior to separation, documented persistent back pain (no radicular symptoms noted) rated “slight [and] frequent” that interfered with running, load-bearing, and heavy lifting.  The physical examination recorded a normal gait without note of tenderness or spasm, and normal neurological findings.  Measured ROM was flexion to 80 degrees (normal 90) and combined ROM of 220 degrees (normal 240).  The CI did not authorize access to his VA records and there was no other post-separation evidence.
The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the lumbar condition 10%, coded 5237 (lumbosacral strain), citing tenderness.  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) and/or combined ROM (greater than 120 degrees but not greater than 235 degrees), 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 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 lumbar condition.  

Bilateral Knee Pain.  The CI developed persistent left knee pain after a strain injury in November 2003, and subsequently developed an atraumatic onset of right knee pain in January 2005.  Bilateral knee X-rays demonstrated some degenerative changes with no other positive findings.  Provider entries in the STR documented grossly normal ROM of both knees with no contrary entries, and there was no note of painful motion for either knee.  There were STR entries that corroborated the absence of effusion, instability, or joint impingement (locking). 

The NARSUM documented persistent bilateral knee pain (no subjective instability or locking noted), with severity and functional limitations encompassed by those above for the lumbar condition.  The physical examination recorded (all findings bilateral) no note of tenderness, and no effusion, instability, or impingement.  Measured ROM was bilateral flexion to 130 degrees (140 normal) and bilateral extension of 0 degrees (normal), with no note of painful motion.  The MEB’s DA Form 3947 submission, the profile, and the commander’s performance statement all listed the condition as “bilateral knee pain,” and were not probative to separate fitness implications for either knee.

The panel directed attention to its recommendations based on the above evidence.  The PEB combined the right and left knee conditions under a single disability rating, coded 5099-5003 (analogous to degenerative arthritis) and rated 10%, referencing the U.S. Army Physical Disability Agency pain policy.  The panel’s initial charge in this case was therefore directed at determining if combining the joints under a single rating was justified in lieu of separate ratings.  Panel members considered that there was no ratable criterion that would support a minimum 10% rating for either knee (as elaborated and justified below); thus, a bilateral rating supported by the 10% criterion of “2 or more major joints” for code 5003 was favorable (and obligatory to avoid lowering the PEB rating).  Members further agreed that, based on the clinical and functional evidence, it was reasonable to conclude that the performance limitations confined to either knee alone (especially the right one) would not have rendered the CI incapable of continuing military service; and, that more likely it was the combined effect of the bilateral condition which rendered him unfit.  With regard to potential individual rating of either knee, members agreed there was not satisfactory evidence of painful motion for either joint to support a minimum 10% rating IAW VASRD §4.59.  There was no evidence for minimum compensable ROM limitation (codes 5260 or 5261), persistent effusion and locking (code 5258), or fracture with nonunion or malunion (code 5262) to support a minimum 10% rating.  There were no other applicable coding or rating options.  Members thus agreed that a 10% rating was supported only by the above 5003 criterion for bilateral rating.  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 bilateral knee condition.  

BOARD FINDINGS:  In the matter of the lumbar condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the bilateral knee 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.  

	PD-2017-04945

XXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXX

	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

	PD-2017-04945