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Dear XXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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 also been provided to the Department of Veterans Affairs and to the counsel you listed on your application, Disabled American Veterans (DAV), 

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-05238
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060512

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E5, Cannon Crewmember, medically separated for “left knee pain” and “chronic low back pain,” rated 0% each, with a combined disability rating of 0%.  

CI CONTENTION:  “My injuries caused me to not only be deemed unfit for military service but they caused me to be unable to continue my civilian profession as a welder, yet the military offered me zero compensation.”  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 – 20060204 	VARD – 20061003 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain	5003	0%	ACL Tear, Left Knee with CMP	5099-5024	10%	20060814	
Chronic Low Back Pain	5299-5237	0%	DJD, Lumbar Spine	5010-5242	10%	20060814	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  50% 	

ANALYSIS SUMMARY:  

Left Knee Pain and Swelling.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent surgery in August 2005 to repair a medial meniscal tear and patellar (kneecap) cartilage.  The 29 December 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, showed range of motion (ROM) of extension to 0 degrees (normal) and flexion to 130 degrees (normal 140) with pain from 90-130 degrees.  The 6 January 2006 MEB NARSUM examination, 5 months prior to separation, noted complaints of persistent knee pain with giving-way; it was improved from prior to surgery though.  Locking was not recorded.  The physical examination showed a stable knee without effusion.  Crepitus of the patella was present and a patellar grind was positive.  X-rays were normal.  No comment was made on signs of meniscal irritation; an orthopedic note from 1 month earlier had recorded these were negative.  

At the 14 August 2006 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported using a brace occasionally.  The physical examination showed an effusion, crepitus and signs of meniscal irritation.  There was 0-120 degrees of painful motion.    The knee remained stable.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 0%, coded 5003 (degenerative arthritis), noting arthritis of one major joint.  The VA rated the left knee condition 10%, analogously coded 5024 (tenosynovitis), based on the C&P examination, citing painful and limited motion.  The panel observed that limited and painful motion as well as a symptomatic knee following a partial meniscectomy support a 10% rating.  The code 5259 (symptomatic removal of a meniscus) was thought to be the most appropriate code.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the left knee condition, coded 5259.  

Chronic Low Back Pain.  According to the STR and MEB NARSUM, the CI’s back condition began during National Guard summer camp training in 2001, and was exacerbated in November 2004 when he was involved in a HMMWV motor vehicle accident.  Radiographic studies showed degenerative joint disease (DJD) and degenerative disc disease (DDD).  An evaluation in physical therapy on 13 December 2005 noted full ROM, but pain with extension.  

During the MEB examination the CI reported ongoing back pain.  The physical examination was checked normal.  The MEB NARSUM examination, 5 months prior to separation, noted complaints of daily back pain, but without neurological deficits.  The physical examination showed full ROM.  No comment was made regarding painful motion, tenderness or gait.  The neurological examination was intact.  Spasm was absent.  

At the C&P examination the CI reported non-radiating low back pain that impaired activity.  The ROM was full, but painful on examination.  There was no additional limitation with repetition.  The neurological examination and gait were normal.  Tenderness and spasm were absent.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 0%, analogously coded as 5237 (lumbosacral strain), citing normal ROM values and a normal neurological examination.  The VA rated the back condition 10%, coded 5010-5242 (arthritis due to trauma - degenerative arthritis of the spine) based on the C&P examination, citing painful motion.  The panel noted that both DDD and DJD were present on MRI and X-rays.  The ROM was full, but painful motion was noted on several examinations.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the back condition, coded 5237.  

BOARD FINDINGS:  In the matter of the left knee condition, the panel recommends a disability rating of 10%, coded 5259 IAW VASRD §4.71a.  In the matter of the back condition, the panel recommends a disability rating of 10%, coded 5237 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Left Knee Pain 	5259	10%	
Chronic Low Back Pain	5237	10%	
COMBINED	20%