RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2021-00035
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20091115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Unit Supply Specialist, medically separated for “chronic cervical pain” and “chronic left knee pain, post anterior cruciate ligament (ACL) repair,” rated 10% each, with a combined disability rating of 20%.

CI CONTENTION:  “I had surgery on 2 of the conditions.  The conditions are getting worse.  Pain and weakness of extremities.”

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 - 20090911	VARD - 20100922	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Cervical Pain	5299-5243	10%	Cervical Strain without Upper Extremity Radiculopathy	5237	10%	20091216	
Chronic Left Pain, Post ACL Repair	5099-5003	10%	Left Knee Degenerative Arthritis S/P ACL Repair	5010-5260	10%	20091216	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic Cervical Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s cervical spine (neck) pain began in May 2008 after riding in a HMMWV going up and down hills which caused his neck to jerk.  The 6 May 2009 cervical spine MRI, 6 months prior to separation, showed a left paracentral disc protrusion at C5-C6 causing mild to moderate left central canal stenosis, and a mild broad bulge at C3-C4.  X-rays showed osteophyte formation at C5-C6.  

During the 11 June 2009, MEB NARSUM examination, 5 months before separation, the CI complained of chronic neck pain and stiffness.  Physical examination showed no cervical spine tenderness, and no spasm or neck deformity.  Cervical spine ROM was flexion at 70 degrees (normal 45) and combined ROM was 365 (normal 340).  Sensation was normal in the upper extremities.  Painful motion was elicited during ROM. 

The 16 December 2009 VA Compensation and Pension (C&P) examination, 2 months before separation, was not in available evidence.  The panel referenced the 22 September 2010 VA Rating Decision to capture the C&P physical examination findings.  There was no neck muscle spasm, tenderness, guarding, weakness, and loss of tone or atrophy of the limbs.  Cervical spine ROM was flexion to 45 degrees (normal) and combined ROM was 340 degrees (normal).  Painful motion was elicited.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the cervical pain condition 10%, analogously coded 5299-5243 (intervertebral disc syndrome (IVDS)), citing painful motion. The VA also rated the cervical condition 10%, coded 5237 (cervical strain), based on the C&P examination, citing painful motion.  The panel agreed there was no limitation of cervical spine motion to support a 10% rating under the General Rating Formula for Diseases and Injuries of the Spine, as reported on the MEB and VA ROM examinations.  However, there was evidence of painful motion to support a 10% rating IAW with VASRD §4.59.  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.  Additionally, there was no documentation of IVDS 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 neck condition.  

Chronic Left Knee Pain Post ACL Repair.  According to the STR and MEB NARSUM, the CI received left knee surgery for an ACL reconstruction on 25 September 2008.  During the 11 June 2009, MEB NARSUM examination, 5 months before separation, the CI complained of left knee pain.  Physical examination of the left knee showed a slight antalgic gait, no instability during Lachman’s and Anterior Drawer testing, and patellar apprehension and inhibition tests were negative.  Active ROM was flexion to 140 degrees (normal) and extension 0 degrees (normal).  Painful motion was not addressed.

The 22 September 2010 VA Rating Decision recorded the following findings.  The CI reported left knee pain, weakness, stiffness, swelling, lack of endurance and the knee giving way.  Physical examination of the left knee showed a normal gait, and no instability (anterior/posterior cruciate stability testing), abnormal movement, effusion, weakness, subluxation or guarding of movement.  Flexion was 140 degrees (normal) and extension was 0 degrees (normal).  Both with pain at the end of ROM.  ROM was additionally limited by pain and weakness following repetitive use; however, measurements were not provided.   

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing painful motion.  The VA also rated the left knee condition 10%, analogously coded 5010-5260 (arthritis, due to trauma - leg, limitation of flexion), based on the C&P examination, citing painful motion. 

The panel agreed there was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, there was objective evidence of painful motion to support a 10% rating based on §4.59, as reported on VA ROM examination.  There was no evidence of recurrent subluxation or lateral instability supporting a rating under code 5257.  There was no evidence of dislocated meniscus or loss body causing frequent locking with recurrent effusions (5258), no history of cartilage (meniscus) “removal” surgery (5259), or fracture, nonunion or malunion of the femur or tibia causing a knee impairment (5255, 5262) to support a higher rating under those codes.  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.  

BOARD FINDINGS:  In the matter of the chronic cervical pain condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the chronic left knee pain post ACL repair 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.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20210207, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20210012711,XXXXXXXXXXXXX. 

Dear XXXXXXXXXXXX:

	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,