RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-05084
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20080509

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Basic Trainee, medically separated for “chronic non- radicular low back pain” and “recurring right knee pain,” rated 10% each, with a combined disability rating of 20%.

CI CONTENTION: Treatment does not work e.g. stretching/physical therapy. 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 - 20080509	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Non-Radicular Low Back Pain	5299-5237	10%	No VA Examination Proximate to Separation	
Recurring Right Knee Pain	5099-5257	10%		
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: NA	

ANALYSIS SUMMARY:

Low Back Pain (LBP). According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s LBP began around October 2007 during basic training without specific injury or trauma, and a lumbosacral spine X-ray was normal. At a primary care visit on 20 November 2007, 6 months before separation, the CI complained of LBP, and the provider noted low back tenderness without spasm. Thoracolumbar spine motion was “normal” with pain. An orthopedic evaluation on 6 December 2007 also noted “normal” lumbosacral spine, and painful motion was not addressed.

During the 8 January 2008 MEB physical therapy (PT) examination, 4 months before separation, the examiner recorded a normal gait and no spinal tenderness, spasm, or guarding. Repetitive thoracolumbar flexion was to 60 degrees (normal 90) with a combined range of motion (ROM) of 205 degrees (normal 240) and painful motion. The 17 January 2008 MEB NARSUM examination noted complaints of chronic LBP. Physical examination showed a normal gait and spinal

tenderness without muscle spasm. Back ROM and painful motion were not addressed. There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the low back condition 10%, analogously coded 5299-5237 (lumbosacral strain), citing ROM limited by pain. Panel members agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees), as reported on the MEB PT examination which was the most VASRD compliant ROM study and proximate to separation. There was no evidence of intervertebral disc syndrome with incapacitating episodes to support 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 low back condition.

Recurring Right Knee Pain. According to the STR and MEB NARSUM, the CI’s right knee pain began at age 14, but became worse during basic training without specific injury or trauma. A knee X- ray was normal, and during the MEB PT examination, the examiner recorded a normal gait and no knee instability. After repetition, goniometrically measured ROM showed right knee flexion to 140 degrees (normal) and extension to 0 degrees (normal); painful motion was not addressed. The MEB NARSUM examination noted complaints of chronic right knee pain without locking or giving way. Physical examination showed a normal gait and no tenderness, effusion, deformity or instability. Right knee ROM and painful motion were not addressed.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right knee condition 10%, analogously coded 5299-5257 (knee, other impairment), citing mild functional loss due to pain. Panel members noted there was no compensable limitation of flexion or extension (5260 or 5261), and after considering other VASRD knee codes, agreed none were not applicable for 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 right knee condition.

BOARD FINDINGS: In the matter of the low back pain condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the right 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.

2	PD-2017-05084

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