RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01056
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070819

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Wheeled Vehicle Mechanic, medically separated for “lumbar degenerative disc disease [DDD]..” and “osteoarthritis right hip…,” rated 10% and 0%, respectively, with a combined disability rating of 10%.  

CI CONTENTION:  The CI contends his condition continues to worsen and a hearing condition which is addressed in the “Scope of Review” below. 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 PEB, but determined 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.  Furthermore, the panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination is based on 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(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, operating 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 the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20070525	VARD – N/A	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar DDD…	5299-5242	10%	No VA  examination in evidence  within 12 months of separation	
Osteoarthritis Right Hip…	5003	0%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Lumbar DDD.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in January 2006 after falling 5 feet off of a 5-ton truck during advanced individual training.  Despite treatment, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.    

During the November 2006 MEB examination (recorded on DD Forms 2807 and 2808), 9 months prior to separation, the physical examination showed tenderness and decreased range of motion (ROM) due to pain.  Radiographic evaluations in December 2006 (X-Rays), January 2007 (MRI), and February 2007 (CT) documented an L5-S1 herniated disc with mild nerve canal narrowing without significant nerve root impingement, multilevel DDD, degenerative joint disease, and no fractures or subluxations.  The 3 April 2007 MEB NARSUM examination, 2 months prior to separation, noted complaints of low back pain without radiation that worsened after prolonged sitting or standing, or with carrying weight.  The physical examination showed flexion to 65 degrees (normal 90) and combined ROM of 155 degrees (normal 240).  There was evidence of painful motion.  Heel and toe walk were normal, and gait was not addressed.  Sensation, strength, and reflexes were normal.  

There was no VA Compensation and Pension (C&P) evaluation within 12 months of separation in evidence for review.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5299-5242 (degenerative arthritis of the spine), citing ROM limited by pain without neurologic deficit.  The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion greater than 60 degrees but not greater than 85 degrees and/or combined ROM greater than 120 degrees but not greater than 235 degrees reported on the MEB NARSUM examination.  There was no documentation of muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour in support of a higher rating.  There was no documentation of physician prescribed bed rest for incapacitating episodes to support a higher rating under that formula.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the back condition.  

Osteoarthritis Right Hip.  According to the STR and the MEB NARSUM, the CI’s right hip condition also began in January 2006 during advanced individual training.  Radiographic evaluation (X-Rays and bone scan) in February and May 2006 documented no bone, joint, or soft tissue abnormalities.  At five visits to physical therapy in February, June, July, and August 2006, all documented painful motion.  ROMs for flexion were documented to be “full” or reach 120 degrees (normal 125).  Extension was described as “full” or to 15 degrees (normal 20).  External rotation was described as “full” or normal.  Abduction measurements were not documented.  Further imaging (MRI) in September 2006 documented no evidence of fracture, dislocation, joint effusion, or soft tissue abnormality.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “early osteoarthritis of the right hip with resulting right hip pain” for PEB adjudication.  

During the November 2006 MEB examination (recorded on DD Forms 2807 and 2808), 9 months prior to separation, the physical examination showed “full ROM and strength” and pain with full flexion.  The 3 April 2007 MEB NARSUM examination, 2 months prior to separation, noted complaints of groin pain while lying in bed, running, jumping or bending.  The physical examination showed flexion to 88 degrees (normal 120), abduction to 30 degrees (normal 45), extension to 15 degrees (normal 20), and normal external rotation.  There was evidence of groin pain with flexion.  The examiner referenced the X-rays from May 2006 as having some evidence of degenerative joint disease (superior acetabular sclerosis).  

There was no VA C&P evaluation within 12 months of separation in evidence for review.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated the right hip condition 0%, coded 5003 (arthritis, degenerative).  The panel considered the evidence for a higher rating.  Members agreed that there was no limitation of motion under codes 5251 (limitation of extension) or 5252 (limitation of flexion) that warranted a rating greater than the 0% adjudicated by the PEB.  However, the panel agreed that there was sufficient evidence of painful motion in support of a 10% rating, analogously coded 5099-5003.  There was no documentation of hip ankylosis, limitation of abduction beyond 10 degrees, inability to cross the legs (adduction), limitation of rotation, or abnormal extension in support of alternate coding resulting in a rating higher than 10%.  There was no evidence of fracture or malunion of the femur.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right hip condition analogously coded 5099-5003.  

BOARD FINDINGS:  In the matter of the back condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the right hip osteoarthritis, the panel unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  There were no other conditions within the panel’s scope of review for consideration.  The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Lumbar DDD… 	5299-5242	10%	
Right Hip Osteoarthritis	5099-5003	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150607, w/atchs
Exhibit B.  Service Treatment Record

AR20170008427, XXXXXXXXXXXXXXXXXX

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Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

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

Sincerely,	 
Enclosure