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AF | PDBR | CY2012 | PD2012 01028
Original file (PD2012 01028.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX         CASE: PD1201028
BRANCH OF SERVICE: Army  BOARD DATE: 20131231
SEPARATION DATE: 20021015


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was a drilling reservist SPC/E-4 (63J/Quartermaster and Chemical Equipment Repairer) medically separated for a low back condition and bilateral knee pain. She began to experience symptoms of low back pain (LBP) in 2000. She sought medical attention from a civilian chiropractor, who diagnosed her with scoliosis. The CI reported problems with her knees beginning in basic training. She was evaluated by a civilian orthopedist and referred to physical therapy for the diagnosis of patellofemoral syndrome, but the treatments were ineffective. She was issued an L3 profile in 2002 and referred for a Medical Evaluation Board (MEB). The MEB forwarded chronic LBP, w/findings of degenerative joint disease and scoliosis, existed prior to service (EPTS); and bilateral knees; anterior knee pain syndrome IAW AR 40-501 to the PEB. The Informal PEB adjudicated LBP secondary to idiopathic scoliosis (ETPS, no deduction), and bilateral knee pain due to patellofemoral pain syndrome rated 10% and 0% respectively. The CI made no appeals and was medically separated.


CI CONTENTION: “Hurt knee and back during service.”


SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2). It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI. The rating for the unfitting bilateral knee and back conditions are addressed below. Any other conditions or contention not requested in this application, remain eligible for future consideration by the Board for Correction of Military Records.

The Board acknowledges the CI’s information regarding the significant impairment with which her service-connected condition continues to burden her; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.


RATING COMPARISON :

Service IPEB – Dated 20020909
 VA - (4 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Low Back Pain Secondary To Idiopathic Scoliosis (EPTS), Permanently Service Aggravated 5295 10% Idiopathic Scoliosis With Upper And Lower Back Strain NSC 20030204
Bilateral Knee Pain Due To PatelloFemoral Pain Syndrome 5099-5003 0% Right Knee Patellofemoral Pain Syndrome NSC 20030204
Left Knee Patellofemoral Pain Syndrome NSC 20030204
No Additional Unfitting conditions
 Other x 1 20030204
Combined: 10%
 Combined: 0%
Derived from VA Rating Decision (VARD) dated 20030317 ( most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Low Back Pain: The orthopedic fitness for duty examination on 17 April 2002, documented the CI’s complaints for mid back pain for 4 years without radiation, which developed gradually over the 4 years. She denied trauma, no paresthesias, no bowel or bladder incontinence, no muscle weakness, some decreased sensation of the right lateral thin and lower leg in a multiple dermatomal distribution. She was unable to run, jump, perform push-ups or sit-ups, no rucksack, and no Kevlar due to back pain. The CI had tried numerous anti-inflammatory medications, physical therapy, chiropractic care, and temporary profiling, all without symptomatic relief. She was unable to perform her Military Occupational Specialty (MOS) duties as a generator mechanic because of her inability to lift more than 25 pounds. Physical examination revealed normal muscle strength, no muscle atrophy, +1 reflexes, decreased sensation at the right lateral and medial thigh, proceeding to the medial and lateral leg, barely visible left thoracic curve starting at T7 – T8 area. Normal gait and normal toe rises. Lumbar spine motion was flexion of 70 degrees (normal is 90), extension of 15 degrees (normal is 30), left lateral bending 30 degrees (30 is normal), right lateral bending 20 degrees (30 is normal). On the MEB narrative summary (NARSUM) dated 17 July 2002, 3 months prior to separation, the CI reported insidious onset of LBP in 2000. She was seen by a civilian chiropractor who diagnosed her with scoliosis and performed regular treatments. Her back pain worsened when she went to MOS school and fell backwards onto a curb while exiting a van. She sought medical treatment, and referred to orthopedics for assessment of fitness for duty. A CT scan showed L5-S1 disk protrusion possibly abutting the L5 and S1 nerve roots. Surgery was not recommended. She re-injured her back in her civilian job lifting some plants, with her pain worsening. She was unable to do repeated bending, heavy lifting, sitting more than 90 minutes, walking more than 90 minutes, standing more than 20 minutes, or running without aggravating her back pain that radiated down her right lower extremity. Physical examination revealed tenderness of the right lumbosacral spine, without spasm or visible deformity, negative straight leg raising test for radiculopathic pain. Range-of-motion (ROM) was flexion 0 – 90 degrees (90 is normal), extension 0 - 20 degrees (normal is 30), left and right lateral flexion 0 – 30 (30 is normal), left and right rotation was 0 – 30 (30 is normal). The VA Compensation and Pension (C&P) exam on 4 February 2003 noted the CI reported frequent back pain, more when active, worsened after pregnancy. Physical examination revealed no paraspinal muscle spasm, no bony tenderness, ROM was flexion 0 - 95 degrees (90 is normal), extension 0 - 35 degrees (30 is normal), lateral flexion 0 – 40 degrees (30 is normal), and rotation 0 – 35 degrees (30 is normal).

The Board directs attention to its rating recommendation based on the above evidence. The PEB rated LBP secondary to idiopathic scoliosis using Veterans Affairs Schedule for Rating Disabilities (VASRD) diagnostic code 5295 (lumbosacral strain) with a 10% rating; the VA did not service-connect or rate the condition. The Board did not find evidence of muscle spasm on extreme forward bending, loss of lateral spine motion, unilateral, in standing position, in the medical record for a higher adjudication under code 5295. The Board did not find any alternate VASRD codes for a higher adjudication, including 5292 (spine, limitation of motion of, lumbar). After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the LBP condition.

Bilateral Knees: The NARSUM noted the CI complained of knee problems since basic training, aggravated by running and jumping, squatting, kneeling, crawling and prolonged standing, with no locking, or mechanical instability. She was treated with anti-inflammatory drugs and short profiles and evaluated by an orthopedist specialist and physical therapy. The treatments were ineffective, and she declined patellar re-alignment surgery. Knee X-rays were normal, and no further treatment options were identified. Physical examination revealed tenderness to pressure of both knees at the medial and lower poles of the patella, positive patellar grind test bilaterally for retropatellar pain syndrome, no effusion, no warmth, no laxity, no Lachman’s test for instability and no McMurray’s test for meniscal tear. ROM were 0 – 145 degrees bilaterally (0 - 140 is normal). On the VA C&P exam on 4 February 2003, the CI reported bilateral knee pain with right worse than left, which began in 1998 during basic training when she fell during running. Physical examination revealed normal strength, normal sensation, normal gait, slight imbalance of tandem gait, able to squat and bend, climb on and off examination table, pain of the left medial knee joint line, no swelling, some crepitus, with no pain throughout ROM of knees that were measured at 0 – 140 degrees (0 – 140 is normal).

The Board directs attention to its rating recommendation based on the above evidence. The VA did not find this condition to be service-connected or provide a rating. The PEB used VASRD codes 5099 (rated analogous to) 5003 (degenerative arthritis) for bilateral knee pain due to patellofemoral pain syndrome with normal X-rays, full ROM, and no joint instability for a 0% rating. The Board found no evidence of ROM abnormalities, painful motion, swelling, muscle spasm, weakness, atrophy, or X-ray abnormalities for a higher rating. There were no other analogous codes that would have given a rating above 0%, including 5262 (leg limitation of flexion) or 5261 (leg limitation of extension). The Board then considered unbundling the right and left knee, and applying the bilateral factor consideration, but the evidence did not support each knee being individually unfit and thus offered no rating advantage to the CI. Additionally the Board considered application of painful motion (§4.59) or functional loss (§4.40) due to pain; however, there was not enough evidence supported by adequate pathology, or evidenced by the visible behavior of pain while undertaking the motions during examinations which included squatting, bending, and climbing on and off examination table for such application. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board majority concluded that there was insufficient cause to recommend a change in the PEB adjudication for the bilateral knee pain condition.


BOARD FINDINGS: IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication. The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised. In the matter of the LBP condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. In the matter of the bilateral knee pain condition, the Board recommends no change in the PEB adjudication by a vote of 2:1. The single voter for dissent (who recommended 5099-5003 at 10%) did not elect to submit a minority opinion. There were no other conditions within the Board’s scope of review for consideration.


RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION
 VASRD CODE RATING
Low Back Pain 5295 10%
Bilateral Knee Pain 5099-5003 0%
COMBINED
 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120831, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record





XXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review
SFMR-RB                                                       

MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXX, AR20140006114 (PD201201028)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual. Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation and hereby deny the individual’s application.
This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

BY ORDER OF THE SECRETARY OF THE ARMY:




Encl                                                  XXXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary
                                                      (Army Review Boards)

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