RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	   CASE:  PD-2014-00655
BRANCH OF SERVICE:  Army  	SEPARATION DATE:  20051104

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated Reserve O-4 (Military Intelligence Officer) medically separated for back pain and ruptured pectoralis muscle.  The conditions could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  He was issued a permanent U3, L3 profile and referred for a Medical Evaluation Board (MEB).  The “failed repair of ruptured left pectoralis major muscle with resulting weakness” and “chronic low back pain (LBP),” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded one other condition (degenerative joint disease (DJD) left knee) for PEB adjudication.  The Informal PEB (IPEB) adjudicated “chronic back pain” and “ruptured left pectoralis muscle” as unfitting, rated 10% and 0%.  The left knee condition was determined to be not unfitting.  The CI appealed to the Formal PEB (FPEB), which affirmed the PEB findings and ratings, and was medically separated.  

CI CONTENTION:  He was given a higher rating for his condition(s) by the VA.  His complete submission is at Exhibit A. 

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’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/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation. 

RATING COMPARISON:  

FPEB - Dated 20050802	VA* - based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5237	10%	Lumbosacral Strain	5237	10%	STR	
			DJD, Multiple Herniated Discs, Lower Back	5003-5243	NSC 		
Ruptured Left Pectoralis Muscle	5303	0%	Status Post Repair Ruptured Left Pectoral Muscle	5303	0%		
DJD Left Knee	Not Unfitting	Status Post Debridement and Partial Medial Menisectomy, Left Knee	5259	Deferred 		
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 1	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20060130 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Chronic Back Pain Condition.  The CI had a long and remote history of intermittent LBP which originated in 1988.  His most current painful flare-up was the result of being struck by a car while deployed in April 2004.  X-rays revealed multi-level degenerative disc disease (DDD) of the lumbosacral spine.  He was not a surgical candidate and despite physical therapy (PT), his LBP symptoms remained.  He was permanently profiled in April 2005 and referred to an MEB.  At the MEB narrative summary (NARSUM) examination (14 April 2005; 7 months pre-Service separation), the CI reported LBP “about 60% of the time.”  His physical examination (PE) revealed decreased range-of-motion (ROM) of the thoracolumbar spine noting forward flexion of 50-60 degrees and a combined ROM of 200-210 degrees.  There was no comment with regards to the presence of painful motion.  His diagnosis remained chronic LBP.  The NARSUM remained the sole clinical encounter document that reflected ROM measurements within one year of separation.   

The Board directed attention to its rating recommendation based on the above evidence.  Both the PEB and VA rated the low back condition at 10% utilizing VASRD code 5237 (lumbosacral strain).  Additionally, the VA rated a condition of multiple herniated discs of the low back as ‘Not Service Connected’.  The Board was confronted with a lack of clinical documentation about the time of Service separation and therefore, members conceded that the NARSUM evaluation at 7 months prior to military discharge be apportioned exclusive examination probative value (PV) in this case.  Members agreed that the thoracolumbar spine ROM of forward flexion clearly supported a 20% impairment level.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the low back condition. 

Ruptured Left Pectoralis Muscle:  On 30 June 2004, the CI sustained a ruptured left-sided pectoralis (chest) muscle tendon while lifting weights.  He underwent surgical repair of the tendon on 18 November 2004.  By late December 2004, there was “clinical and radiologic evidence” that the tendon repair was unsuccessful and re-ruptured.  A repeat surgery was not recommended and he was treated with physical therapy.  In February 2005 (9 months prior to separation), the CI endorsed no pain, but the examination revealed decreased left shoulder ROM and strength.  At the NARSUM examination, the CI complained of left shoulder pain (30% of the time), weakness, and decreased ROM.  He endorsed the inability to lift greater than 15 pounds with reference to the left shoulder/arm.  The PE revealed decreased and painful left shoulder with weakness assessed at 3-4 out of 5 when performing adduction and or internal rotation of the left shoulder.  The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Left Shoulder ROM
(Degrees)	PT ~9 Mo. Pre-Sep
(200502--) 	MEB ~7 Mo. Pre-Sep
(20050414) 	
Flexion (180 Normal)	100	100/105/110	
Abduction (180)	110	110/112/115	
Comments	decreased strength @ 4/5	decreased strength @ 3-4/5; painful motion	
§4.71a Rating	0%	10%-20%	

The Board directed attention to its rating recommendation based on the above evidence.  Both the PEB and VA coded the muscle condition under the appropriate code of 5303 and rated at 0% (slight) impairment.  Board members first deliberated and agreed that the evidence of painful motion at the MEB examination was sufficient to support a 10% impairment rating under VASRD §4.59 (painful motion).  Board members then turned their attention to the specific muscle code of 5303 (chosen by both PEB and VA) and deliberated if the next higher impairment level of 20% (moderate) was supported.  After extensive deliberation, the Board agreed that the specific notation of weakness about the left shoulder girdle reaching down to a level of ‘3’ (3-4 out of 5) did support an impairment level greater than ‘slight’ (0%).  Considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the left pectoralis muscle condition.

Contended PEB Condition.  The Board’s main charge is to assess the fairness of the PEB’s determination that the DJD of the left knee condition was not unfitting.  The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The left knee condition was not permanently profiled or implicated in the commander’s statement and was not judged to fail retention standards.  The condition was reviewed by the action officer and considered by the Board.  There was no performance based evidence from the record that the left knee condition significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the left knee condition and so no additional disability rating is recommended.  

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 low back condition and IAW VASRD §4.71a, the Board unanimously recommends a disability rating of 20%, coded 5237 IAW VASRD §4.73.  In the matter of the torn left pectoral muscle condition, the Board unanimously recommends a disability rating of 20%, coded 5303 IAW VASRD §4.73.  In the matter of the contended left knee condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Chronic Back Pain 	5237	20%	
Ruptured Left Pectoralis Muscle	5303	20%	
RATING	40%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131208, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-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 XXXXXXXXXXXXXXXXXXXXX, AR20160002354 (PD201400655)

1.  Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) pertaining to the individual named in the subject line above to recharacterize the individual’s separation as a permanent disability retirement with the combined disability rating of 40% effective the date of the individual’s original medical separation for disability with Reserve retirement.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum:

	a.  Providing a correction to the individual’s separation document showing that the individual was separated by reason of permanent disability retirement effective the date of the original medical separation for disability with Reserve retirement.

	b.  Providing orders showing that the individual was retired with permanent disability effective the date of the original medical separation for disability with [severance pay] [Reserve retirement].

	c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will account for payment of permanent retired pay at 40% effective the date of the original medical separation for disability with Reserve retirement.

	d.  Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and medical TRICARE retiree options.

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

			      
						      					
Enclosure
					
CF: 
(  ) DoD PDBR
(  ) DVA