RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01821
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050322

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an National Guard E6, Unit Supply Specialist, medically separated for “chronic radiating low back pain” and “chronic right shoulder pain,” rated 0% each, with a combined disability rating of 0%.

CI CONTENTION:  The CI requested a review of all conditions.  The CI’s complete submission is Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited 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.  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 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 - 20050216	VARD - 20050803	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Radiating Low Back Pain…	5243	0%	Lumbar Spine Degenerative Disc Disease, L5-Sl, L4-5, with S1 Nerve Root Impingement	5010-5237 	10%	20050531	
Chronic Right Shoulder Pain…	5099-5003	0%	Right Shoulder Impingement Syndrome and Bicep
Tendonitis	5201-5019	10%		
Gastroesophageal Reflux	Not Unfitting	Gastroesophageal Reflux	7346	0%		
Recurrent Neck Pain		Cervical Strain	5237	10%		
Frequent Headaches		Headache	8100	NSC		
Allergic Rhinitis		Allergic Rhinitis	6522	NSC		
Overactive Bladder		No VA Placement  	
Retropatellar Pain Syndrome		Bilateral Knee Patellar Pain Syndrome	5014	NSC	20050531	
Bunions		Right Foot Bunion	5280	0%		
		Left Foot Bunion	5280	0%		
Costochondritis		Costochondritis Lower Left Rib with Abdominal Wall
Muscle Strain	5299-5297	0%		
Abdominal Wall Tear						
Pes Planus		Bilateral Pes Planus	5276	NSC		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	
ANALYSIS SUMMARY:  

Low Back Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) Narrative Summary (NARSUM), the CI initially developed acute low back pain in June 1999 after lifting a water jug.  Although her symptoms improved with short-term conservative treatment, she experienced multiple episodes of acute back pain over a 5-year period each successfully treated for a short duration.  Follow-up radiologic studies performed in May 2004 revealed a bi-level disc herniation of the lumbosacral spine with space narrowing of exiting nerves.  An Orthopedic consultation to the MEB was performed on 20 September 2004, 6 months prior to separation, which revealed a completely normal spinal examination.  

The 16 November 2004 MEB NARSUM examination, 4 months prior to separation, the CI’s chief complaint was low back pain.  She endorsed that her symptoms were triggered by lying in certain positions, standing more than 30 minutes, sitting more than 1 hour, repeated bending and heavy lifting.  Her physical examination (PE) portion of the NARSUM was performed on 7 October 2004, 5 months prior to separation, which recorded normal range of motion (ROM) of the thoracolumbar spine excepting a 10 degree deficit in extension (20 vs. normal 30 degrees); resulting in a combined ROM of 230 degrees (normal = 240).  There was no local tenderness or spasm present and there was no comment with regard to painful motion.  The provider noted, “A detailed neurological examination was completely normal.”

At the 31 May 2005 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported a constant dull 3/10 pain in the lower back that radiated to the left buttock with flare-ups to 7/10 lasting 2 days once every 2 months.  Her PE revealed a normal gait and normal thoracolumbar ROM noting only a 5 degree deficit in right rotation (25 vs. normal 30 degrees); resulting in a combined ROM of 235 degrees.  Slight tenderness of the lumbar spine was present.      

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back pain condition at 0%, coded 5243 (intervertebral disc syndrome), citing full ROM, no tenderness and no clinical signs of radiculopathy.  The VA rated the same condition at 10% dual coded 5010-5237 (traumatic arthritis-lumbosacral strain), based on the C&P examination 2 months after separation, citing ROM greater than 120 degrees but not greater than 235 degrees.  Panel members agreed that there was no limitation of thoracolumbar spine motion to support a minimum rating under the General Rating Formula for Diseases and Injuries of the Spine.  Although the VA examination noted a degree of localized tenderness in the lumbar spine, the panel majority agreed that the description of “slight” when considered in context to the entire STR, did not rise in support of a positive impairment rating.  Therefore, 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 low back pain condition.  

Right Shoulder Pain.  According to the STR and the MEB NARSUM, the right-hand dominant CI injured her right shoulder in late 2001 without any specified direct trauma.  Radiographic imaging of the right shoulder was normal.  According to the MEB NARSUM evaluation on examination on 11 November 2004 (4 months prior to separation) the CI complained of shoulder pain aggravated by lifting above shoulder level, throwing, and upon direct pressure.  Shoulder dislocations were not reported.  Her PE at 6 months prior to separation revealed “full” ROM of the right shoulder with crepitus.  Local tenderness was present.  At the 25 October 2005 VA C&P examination, performed 7 months after separation, the CI reported increased right shoulder pain with essentially all aspects of movement.  Her PE revealed mild tenderness and crepitus.  Shoulder ROM was decreased with flexion at 160 degrees (normal = 180) and abduction at 162 degrees (normal = 180).  Painful motion was noted with abduction.   

The panel directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under the analogous 5099-5003 code (traumatic arthritis), citing degenerative joint disease with normal radiographs and motion.  The VA assigned a 10% rating using a dual 5201-5019 code (limitation of arm motion-bursitis) for painful or limited motion of a major joint or group of minor joints.  The VASRD §4.71a threshold for rating for ROM impairment with code 5201 (arm limitation of motion) is “at shoulder level” (approximately 90 degrees from the side), and the examinations in evidence demonstrated motion well above this level.  However, panel members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion) as demonstrated at the VA examination.  There was no mal-union or recurrent dislocation of the humerus and no dislocation or nonunion of the clavicle or scapula to justify a higher rating under other alternative codes.  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 shoulder condition.  
  
Contended PEB Conditions:  Gastroesophageal reflux, recurrent neck pain, frequent headaches, allergic rhinitis, overactive bladder, retropatellar pain syndrome, bunions, costochondritis, abdominal wall tear, and pes planus.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions of were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at or near separation.  After due deliberation, the  panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the low back pain condition and IAW VASRD §4.71a, the panel majority recommends no change in the PEB adjudication.  The single voter for dissent recommended modification to 10% and did not elect to submit a minority opinion.  In the matter of the right shoulder pain condition, the panel unanimously recommends a disability rating of 10%, coded 5024 (tenosynovitis) IAW VASRD §4.71a.  In the matter of the contended conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  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	
Low Back Pain	5243	0%	
Right Shoulder Pain	5024	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150623, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170008810, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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