RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01449
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20020620

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Self-Propelled Field Artillery Systems Mechanic, medically separated for “chronic mid and low back pain,” with a disability rating of 10%.

CI CONTENTION:  His conditions continue to worsen and negatively impact his daily activities.  He was not evaluated a right knee condition or ringing in his ears.  His 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 panel 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 determinations 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 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 - 20020422	VA - 20020228	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Mid and Low Back Pain	5299-5295	10%	Lumbar Strain	5295	10%	20020228	
			Thoracic Strain	5299-5291	0%		
RPPS Left Knee	Not Unfitting	Retropatellar Pain Syndrome, Left Knee	5299-5257	0%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Chronic Mid and Low Back Pain.  The PEB combined the mid (thoracic) and low (lumbar) back pain conditions as a single unfitting condition under an analogous 5295 code (lumbosacral strain) and rated 10%.  The approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications or implied adjudication that each condition was separately unfitting.  The panel’s initial charge in this case was therefore directed at determining if the PEB’s approach of combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  The evidence for the mid and low back pain conditions are presented together, with attendant recommendations regarding separate unfitness and rating in the rating discussion.

According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the back pain condition began approximately 4 years prior to referral for MEB.  The 21 June 1999 lumbar spine and pelvis radiographic (X-rays) studies were normal.  At the 28 February 2002 VA Compensation and Pension (C&P) examination, 4 months before separation, the CI reported onset of his mid and lower back condition in 1999.  “The veteran states that he lifted a piece of equipment which is usually lifted by two men.  He felt a pop and pain in his mid-back region, he set the equipment down and reported for medical help.”  He complained of constant pain and inflammation in the mid and lower back regions.  The CI denied radiation of pain into the legs and bowel or bladder complaints.  Lower spine pain was exacerbated by prolonged standing, prolonged walking, running, heavy lifting, and certain movements and incompletely relieved by medication and "cracking his back."  He did not experience significant improvement with activity modification, physical therapy (PT), chiropractic manipulation, and medication.  The physical examination documented a normal posture and gait with no assistive devices.  The thoracic spine examination revealed mid-thoracic midline tenderness and no thoracic vertebrae ankylosis (joint stiffening or immobility).  Thoracic spine range of motion (ROM) was “normal.”  The lumbar spine examination revealed diffuse high lumbar midline tenderness.  Lumbar spine active ROM was normal.  “There is no Deluca issue regarding thoracolumbar motion.”  The straight leg raise (SLR) test for radiculopathy was negative.  Strength, sensation, and deep tendon reflexes (DTRs) were normal.  Thoracic and lumbar spine X-rays were normal.  The diagnosis listed thoracic and lumbar spine strain.  

At the 26 March 2002 NARSUM, 3 months before separation, the CI complained of a 2-year history of recurrent low back pain.  He complained of progressive worsening of low and mid back pain over the previous year.  The daily 7-8/10 pain lasted from a few hours to the entire day.  The CI denied radiating pain, radiculopathy (nerve root irritation or injury), or loss of bowel or bladder control.  Symptoms were exacerbated by activity, exercise, work, running, and heavy lifting and incompletely relieved by medication (Tylenol).  He did not experience significant improvement with conservative management (activity modification, PT, chiropractic manipulation, and medication).  The physical examination documented a normal gait and the CI was able to heel and toe walk.  The spine examination revealed a midline spine with normal curvature.  There was diffuse midline paraspinal muscle tenderness in the lower lumbar (L3 to sacrum) and mid thoracic (T6) regions.  Spine active ROM was flexion of 75 (fingertips ~ 6 inches from floor), extension of 30, bilateral lateral flexion of 30, and bilateral rotation of 30 degrees.  The SLR tests were negative.  Strength, sensation, and DTRs were normal and pathologic reflexes were absent.  The thoracic and lumbar spine nuclear medicine bone scan and X-rays were negative.  The diagnoses listed chronic mid thoracic back pain and low back pain.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating for the mid and low back condition under an analogous 5295 code (lumbosacral strain) citing chronic mid and low back pain, with characteristic pain on motion, no neurologic abnormality, and no chronic paravertebral muscle spasms.  The VA assigned a 10% rating for the lumbar condition under the 5295 code (lumbosacral strain) based on the VA C&P examination 4 months before separation, citing characteristic painful or limited motion.  The VA assigned a 0% rating under an analogous 5291 code (spine, limitation of motion of, dorsal) based on the VA C&P examination citing a non-compensable evaluation was assigned for slight limitation of motion of the dorsal spine.  In accordance with DoDI 6040.44, the panel is required to recommend a rating IAW the VASRD in effect at the time of separation.  The panel noted that the 2002 VASRD standards for the spine, which were in effect at the time of separation, were changed to the current §4.71a rating standards in 2004.  There was no vertebral fracture (5285), complete spine ankylosis (5286), dorsal spine ankylosis (5288), lumbar spine ankylosis (5289), limitation of dorsal spine motion (5291), limitation of lumbar spine motion (5292), or sacroiliac injury/weakness (5294) for consideration under the respective codes.  There was no neuropathy, characteristic pain, muscle spasm, absent DTR, neurological findings appropriate to disc site, or recurring attacks for consideration under intervertebral disc syndrome (5293).  

Panel members agreed a 10% rating was supported under lumbosacral strain (5295) based on characteristic pain on motion.  The panel concluded that the evidence did not provide sufficient grounds for recommending separate disability ratings in this case, and that the combined rating of 10%, coded 5299-5295, is a good analogy to both the pathology and disability.  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 mid and low back condition.  

Contended PEB Condition: Retropatellar Pain Syndrome, Left Knee.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the chronic mid and low back pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended retropatellar pain syndrome left knee condition, the panel unanimously recommends no change from the PEB determination as not unfitting.  There were no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be 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 20150602, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170004753, XXXXXXXXXXXXXXXXXX 

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Dear XXXXXXXXXXXXXXXXXX:

	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,					       
						      					
Enclosure