RECORDOF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXX
BRANCH OF SERVICE: ARMY

CASE:  PD-2020-0015 1
SEPARATION DATE: 200702 14

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (Cl) was an active duty ES, CH-47 Helicopter Rep airer, medicall y separated for "low back pain" and "right hip and knee pain," rated 10% and 0%, respectively, with a combined disability rating of 10%.

Cl CONTENTION: "With minimal changes to my conditions for discharge my rating with the VA is at 40%...." The complete submission is at Exhibit A.

SCOPE OF REVIEW: The panel' s scope of review is defined in DoDI 6040.44. It is limite d to review of disability rati ngs assigned to those conditions dete rmined by the Physical Evaluation Board (PEB) to be unfitting for continued milit ary service, and when specifically requested by the Cl, those conditions identifi ed by the Medical Eva luation Board (M EB), but determi ned by the PEB to be not unfi tt ing or non-compe nsable. Any conditions outside the panel' s defined scope of review, and any cont ention not requested in this application , may remain eligi ble for future consideration by t he Board for Cor rect ion of M ili t ary Records. The panel' s authority is limited to assessni g t he fairness and accuracy of PEB rating determinations and recommending corrections when appropriate. The panel gives consideration to VA evide nce, particularly within 12 mont hs of separation, but only to the extent that it reasonab ly refl ect s the severi ty of disabili ty at the time of separation.

RATINGCOM PARISON:

SERVICE PEB - 200 611 27	VARD-NA	
Condition	Code	Rating	Condition	I	Code	I  Rating I	Exam	
Chronic Low Back Pain...	5237	10%	No VA Examinat ion Proximat e t o Separa t ion in Evidenc e	
Right Hip and Knee Pain...	5099-5003	0%		
COM BINED RATING: 10%	COM BINEDRATING OF ALL VA CONDITIONS: NA	

ANALYSISSUMMARY:

Chronic Low Back Pain. According to the service treatmen t record (STR) and MEB narrative summary (NARSUM), the Cl' s back pain began as early as November 2002 with no known injury or trauma. During the 28 Ju ly 2006 MEB exami nation (recorded on DD For ms 2807-1and 2808), 7 months prior to separation, the Cl re por t ed "needle point pain up to mid-back ." Physica l exami nation revea led lumbar spine range of mot ion (ROM) pain with flexion to 70 degrees  (no rmal 90). A month later, the MEB NARSUM examinat io n noted complaints of lowe r back pain, responsib le fo r 80% of his pain symptoms. Physica l examination revealed tendernessin the lower lumbar spine. There was no VA examination proxima t e to separation in evidence.

The panel directed att ention to its rating recommendat io n based on the above evidence. The PEB rated the low back pain at 10%, coded  5237  (lumbosacral  strain),  citing  his  physical exami nation noted lower spine tenderness.

The panel agreed that a 10% rating, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) and supported by the presence of localized tenderness. 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 evidence of intervertebral disc syndrome which resulted in incapacitating episodes requiring physician- prescribed bed rest to warrant consideration of rating under that alternate VASRD 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.

Right Hip and Knee Pain. According to the STR and MEB NARSUM, the CI underwent a right hip arthroscopy in February 2006 to repair a torn labrum. He also underwent surgery on his right knee in March 2006 for peroneal nerve decompression and relocation. During the MEB examination, the CI reported numbness and sharp pain and the inability to walk more than a few feet due to right knee pain. Physical examination showed the right hip dislocating with flexion while in the Trendelenburg position (lying supine on a 30-degree tilted table). There was painful flexion of the right knee but no indication of limitation of motion.

At the 17 August 2006 physical therapy MEB ROM examination, 6 months before separation, the CI reported right knee and hip pain. Right and left knee ROM both showed flexion of 130 degrees (normal 140), and extension of 0 degrees (normal) after repetition. Right hip ROM measured in degrees showed abduction of 40 (normal 45), extension of 15 (normal 30), and flexion of 110 (normal 125) after repetition. The examiner recorded excessive ROM during right hip external rotation, and there was decreased muscle strength in the right hip with evidence of instability of the hip joint that affected the ROM.

The 30 August 2006 MEB NARSUM examination noted the complaint of “I am here for my right hip, right knee and lower back pain.” He stated that his leg symptoms were about 20% of his pain and his back symptoms 80% of his pain. The CI had right hip arthroscopy in February 2006 that revealed significant chondral deficiency of the right hip joint. He also had peroneal nerve decompression of the right leg in March 2006. Since knee surgery, he continued to have knee pain occasionally and no instability symptoms. Physical examination revealed antalgic gait favoring the right hip, and normal motor strength in bilateral lower extremities. Right hip examination showed pain with flexion, adduction and internal rotation. There was tenderness over the greater trochanter and over the groin. 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 bundled the right hip and knee pain conditions and applied a single 0% rating, coded 5099- 5003 (analogous to degenerative arthritis), with application of the US Army Physical Disability Agency pain policy, citing “rated for pain as slight and intermittent.” In this case, the right hip and right knee joints combined by the PEB were separately considered to fail retention standards and were listed separately by the MEB and similarly separately implicated by the NARSUM, as well as separately noted on the permanent L3 profile, dated 27 June 2006. Since undue speculation would be required to conclude that impairment from either the right hip or the right knee would not have unacceptably interfered with the performance of military duties, members agreed that each condition was reasonably justified as separately unfitting. Accordingly a separate disability rating is recommended for the right hip and for the right knee.

For the right knee, the discussion was centered on the MEB history and physical examination, 7 months before separation, and the PT ROM examination, 6 months before separation. Panel members noted the absence of ROM measurements, but there was the report of painful motion with flexion during the MEB. The panel majority agreed a rating was justified based on painful motion. Panel members also noted the absence of report of painful motion in the PT

examination; however, there was a quest ion on limit at ion of mo tio n. Both knees had 130 degrees of flexion. After considerable deliberatio n, panel members concluded, there was no compensab le limit ation of flexion or extension that supported a rat ing under the VASRD diagnostic codes for limitation of motion (5260 or 5261). Likewise, there was no history or evidence of dislocat ed meniscus or loose body causing frequent locking with recurrent effusions (5258) to support a rat ing under that code. There was no fr acture, 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). However, the panel majority agreed the re was sufficient evidence of painfu l motion with functional loss based on VASRD §§4.59, 4.40 and 4.45 to support a 10% rati ng.

The panel next considered the evidence for the right hip condition. There was no limitation of motion which supported a rating under the diagnostic codes for limit at ion of thigh flexion, extension, or thigh impair ment (5251, 5252, and 5253). There was no fr acture, nonunion or malunion of the femur or tibia, however, panel members agreed, there was evidence of slight hip disability favoring a 10% rating under code 5255 (femur, impairment) demonstrated du ring the NARSUM, MEB and PT examinations that showed antalgic gait favoring the right hip and hip joint instability  during certain  maneuvers such  as Trendelenburg.	After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt ), the panel recommends an unfit determination and a disability rati ng of 10% for the right hip condition , coded 5099-5255; and an unfit determination with a disability rating of 10% for the right knee condition , coded 5099-5260 (leg, limit ation of fl exion).

BOARD FINDINGS: In the matter of the chronic low back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the bundled right hip and right knee conditions, the panel recommends that this be adjudicated for two separate conditions. In the matter of the right hip condition, the panel recommends a separate ly unfi t determination with a disability rating of 10%, coded 5099-5255 IAW VASRD §4.71a. In the matte r of the right knee condition, the panel majority recommends a separate ly unfit determination with a disability rati ng of 10%, coded 5099-5260 IAW VASRD §4.71a. The single voter for dissent recommends a separate ly unfit determination with a disability rating of 0% for the right knee condition and did not elect to submit a minorit y opinion.

The panel recommends the Cl' s prior determination be modifi ed as fo llow s; and, that the discharge with severance pay be re-characterized to r eflect permanent disability retire ment, effective the date of medical separation:

CONDITION	VASRDCODE	PERMANENT RATING	
Chronic Low Back Pain	5237	10%	
Right Hip Pain	5099-5255	10%	
Right Knee Pain	5099-5260	10%	
	COMBINED	30%	

The fo llowing documentary evidence was considered

AR20210005115,

Dear

DEPARTMENT OF THE ARMY
ARMY REVIEW BOARDS AGENCY 251 18TH STREET SOUTH, SUITE 385
ARLINGTON, VA  22202-3531

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a permanent disability retirement with the combined disability rating of 30% effective the date of your medical separation for disability with severance pay. Enclosed is a copy of the Board's recommendation and record of proceedings for your information.

The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.

The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances. These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits. Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), 1835 Army Boulevard, Building 2000 JBSA, Fort Sam Houston, TX 78234.

A copy of this decision has been provided to the Department of Veterans Affairs.

Sincerely,

Enclosure

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