RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-05919
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081130

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E6, Cavalry Scout, medically separated for “arthritis, degenerative of left knee” and “degenerative arthritis of the spine,” 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 - 20081028	VARD - 20090814	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Arthritis…Left Knee	5003	10%	Left Knee Postoperative Degenerative Joint Disease	5010	10%	20090420	
Degenerative Arthritis of the Spine	5242	10%	Thoracolumbar Degenerative Disc Disease	5242	20%	20090420	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Left Knee Degenerative Arthritis.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent a partial medial meniscectomy in 2006.  He continued to have anterior and medial-sided knee pain, and an arthroscopy in June 2008 showed Grade III chondromalacia involving the posterior aspect of the patella and medial compartment of the knee, as well as a meniscal tear, which was debrided.  Despite some improvement, the left knee continued to be symptomatic.
  
The 11 August 2008 MEB NARSUM examination, 3 months prior to separation, noted CI complaints of mild medial and anterior knee pain.  He reported daily flare-ups which included stiffness and increased pain which resolved after “working the knee out.”  Physical examination showed well-healed anterior incisions and mild varus alignment with a small effusion and full range of motion (ROM).  There was retro patellar and trochlear tenderness with mild patellar crepitus as well as mild medial joint line tenderness.  Varus-valgus stress testing was normal, and left lower extremity strength was 5/5.  A follow-up post-separation examination in December 2008, showed full ROM and no evidence of left knee swelling or crepitation. 

At the 20 April 2009 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported kneecap pain.  Although he denied weakness, dislocation or subluxation, he complained of daily locking episodes, which occurred more often with effusions.  Physical examination showed pain, stiffness, limited motion, instability and swelling of both knees.  Measured ROM showed flexion of 120 degrees (normal 140) and extension of 0 degrees (normal).  There was pain following repetitive motion, but no additional limitations.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded 5003 (degenerative arthritis), citing functional impairment IAW VASRD §4.10, §4.40 and §4.59.  The VA rated the left knee condition 20%, coded 5010 (traumatic arthritis), based on the C&P examination, citing painful or limited motion.  Panel members noted there was no limitation of flexion or extension which supported a rating under diagnostic codes 5260 or 5261.  However, there was evidence of painful motion to warrant a 10% rating IAW §4.59.  There was also a history of partial removal of a meniscus (5259) to support a rating under that code, but this did not offer any rating advantage to the CI.  The NARSUM examination showed evidence of a small effusion but there was no report or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) prior to separation.  There was no fracture, nonunion or mal-union 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 left knee condition.  

Degenerative Arthritis of the Spine.  According to the STR and MEB NARSUM, the CI experienced mid and low back pain in 2004 after running, jumping, and carrying heavy equipment.  Lumbar spine imaging demonstrated L3-L4 and L5-S1 degenerative disc disease with spinal stenosis.  The MEB NARSUM examination noted complaints of mid and low back pain radiating into the right buttocks and medial great toe with numbness and tingling in the same distribution.  He also had daily flare-ups which further limited activity.  Physical examination showed muscle spasm, but the CI had a normal heel-to-toe gait and no gross deformity.  There was diffuse thoracolumbar tenderness, but goniometrically measured ROM was full, and reflexes, sensation and motor strength were normal.

At the  C&P examination the CI reported his back pain had a moderate effect on chores, shopping and exercise, but did not affect other activities of daily living; he was not employed.  Physical examination showed an antalgic gait, pain with radiation and numbness in the left leg, stiffness, limited motion, and swelling.  There was thoracic and lumbar paraspinal tenderness, and straight leg raise testing was positive.  Thoracolumbar ROM measurements showed flexion to 55 degrees (normal 90) and extension to 20 degrees (normal 30), with pain following repetitive motion but no additional limitation.  Spine X-rays showed a mild compression deformity of several mid thoracic vertebral bodies and mild degenerative changes.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5242 (degenerative arthritis of the spine) citing functional impairment.  The VA rated the back condition 20%, also coded 5242, based on the C&P examination, citing flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees.  In regards to the conflicting ROM values, panel members agreed the MEB NARSUM held more probative rating value than the C&P examination because it was closer to separation and better reflected the CI’s disability at separation.  Although there was insufficient limitation of motion to support a minimum rating, the panel agreed a 10% rating was justified for the presence of painful motion.  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, 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 left knee condition and IAW VASRD §4.71, the panel recommends no change in the PEB adjudication.  In the matter of the back condition and IAW VASRD §4.71, 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.  

AR20190007336, 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.