RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00087
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040604

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Senior Logistic Specialist, medically separated for “chronic low back pain,” “right shoulder pain,” and “chronic [right] retropatellar pain syndrome,” rated 10%, 0% and 0%, respectively, with a combined disability rating of 10%.

CI CONTENTION:  The CI contends his back condition.  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 - 20040604	VARD - 20041221	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5299-5237	10%	Low Back Strain	5237	10%	20041002	
Right Shoulder Pain	5099-5003	0%	…Right Shoulder Dislocation…	5201	0%	20041002	
Chronic [Right] Retropatellar Pain Syndrome	5099-5003	0%	Right Retropatellar Pain Syndrome	5262	10%	20041002	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

Chronic Back Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back pain condition began after she fell off a five-ton truck in February 1996 and then again in March 1997.  Radiographic imaging (X-ray) revealed scoliosis.  The 23 January 2004 MEB NARSUM examination, 7 months prior to separation, noted complaints of sharp low back pain.  Physical examination showed a normal posture and gait.  Spinal tenderness to palpation and 2/5 Waddell’s signs were positive.  Bilateral straight leg raise test (for radiculopathy) was negative.  The range of motion (ROM) was flexion of 55 degrees (normal 90), extension 10 degrees, and right lateral flexion 10 and left 20 degrees; painful motion was present.  

At the 02 October 2004 VA Compensation and Pension (C&P) Joints evaluation, performed 2 months after separation, the CI reported constant low back pain near the tailbone region without significant radiating pain, and denied any incapacitating episodes in the past 12 months.  Physical examination showed a normal gait and the ability to toe and heel raise without difficulty.  ROM was flexion 85 degrees and combined ROM was 235 degrees (normal 240); painful motion was present.  X-ray imaging revealed L5-S1 degenerative disc disease.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back pain condition 10%, analogously coded 5299-5237 (lumbosacral strain), citing moderately restricted ROM (flexion 55 degrees).  The VA also rated the low back condition 10% coded 5237, based on the VA C&P examination 2 months after separation, citing limitation of motion.  The panel noted the disparity between the MEB NARSUM and C&P ROM examinations and deliberated their probative value.  The panel determined the C&P examination had the highest probative value since the examination was comprehensive and most proximate to separation.  The C&P examination addressed all ROMs and painful motion, while the MEB NARSUM ROM was incomplete.  The panel therefore agreed the C&P examination (flexion 85 degrees) only 2 months after separation supports a 10% rating based on limitation of flexion (greater than 60 degrees but not greater than 85 degrees).  There was no evidence of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula or evidence of ratable peripheral nerve impairment which would provide for additional rating.  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 pain condition.

Right Shoulder Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right shoulder condition began during basic training while going through the obstacle course.  A right shoulder Bankart lesion repair (for instability) was performed on 13 Feb 2003.  A 12 September 2003 physical therapy examination, 11 months prior to separation, noted complaints of increased shoulder pain 2-3/10.  Physical examination showed range of motion (ROM) of flexion to 145 degrees (normal 180) and repetitive abduction of 135/50/50/85 degrees (normal 180); painful motion was not addressed. 

The 23 January 2004 MEB NARSUM examination, 7 months prior to separation, noted complaints of right shoulder pain.  The examiner referenced the aforementioned physical therapy ROM performed on 12 September 2003.  A 30 March 2004 physical therapy examination, 4 months prior to separation, noted complaints of continued shoulder pain 5/10.  Physical examination revealed repetitive ROM of flexion to 135/138/140 and abduction 112/114/112 degrees; painful motion was present.  At the 02 October 2004 VA Compensation and Pension (C&P) evaluation, performed 2 months after separation, the CI reported a sore shoulder with decreased ROM aggravated with over-head type activities or lifting heavy objects.  Physical examination showed ROM of flexion to 150 degrees and abduction 135 degrees; painful motion was present. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy.  The VA rated the right shoulder condition 0% coded 5201 (arm, limitation of motion), based on the VA C&P examination 2 months after separation, citing non-compensable limited ROM.  The panel agreed the physical therapy and C&P ROM examinations most proximate to separation did not reveal ROMs to support the minimal compensable 20% rating under 5201 code.  However, the panel agreed that both examinations documented VASRD §4.59 (painful motion) to justify the minimal compensable 10% rating.  There was no mal union or recurrent dislocation of the humerus to justify a higher rating under the 5202 code (humerus, other impairment of); and no nonunion with loose movement of the clavicle to warrant a higher rating under the 5203 code (clavicle or scapula, impairment of).  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, coded 5299-5201.

Right Knee Retropatellar Pain Syndrome.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee pain condition began after she twice fell off a five-ton truck in February 1996 and then March 1997.  The 23 January 2004 MEB NARSUM examination, 7 months prior to separation, noted complaints of right knee pain.  Physical examination showed no tenderness to palpation or effusion, with positive crepitus and ROM was normal (flexion normal 140 degrees and extension normal 0); painful motion was not addressed. 

At the 02 October 2004 VA Compensation and Pension (C&P) evaluation, performed 2 months after separation, the CI reported intermittent right knee pain aggravated with prolonged seating, going up or down stairs, or running.  Physical examination showed no knee instability, good patellofemoral tracking, but positive for mild patellar grind discomfort.  ROM was flexion to 135 degrees and extension to 0 degrees; painful motion was present. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, analogously coded 5099-5003 (degenerative arthritis).  The VA rated the right knee condition 10% coded 5262 (tibia and fibula, impairment), based on the VA C&P examination 2 months after separation, citing slight knee disability.  The panel noted the disparity between the MEB NARSUM and C&P ROM examinations and deliberated their probative value.  The panel determined the C&P examination had the highest probative value since the examination was comprehensive and most proximate to separation.  The C&P examination provided quantified flexion and extension ROM and addressed painful motion, while the MEB NARSUM examination only cited normal ROM and did not address painful motion.  The panel agreed there was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  There was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) or history of surgery to remove a meniscus (5259) to support a rating under the respective codes.  There was no fracture, non-union, or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  However, there was C&P evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  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 knee condition, coded 5299-5260.

BOARD FINDINGS:  In the matter of the chronic back pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the right shoulder pain condition, the panel unanimously recommends a disability rating of 10%, coded 5299-5201 IAW VASRD §4.71a.  In the matter of the chronic [right] retropatellar pain syndrome condition, the panel unanimously recommends a disability rating of 10%, coded 5299-5260 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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Back Pain 	5299-5237	10%	
Right Shoulder Pain	5299-5201	10%	
Chronic [Right] Retropatellar Pain Syndrome	5299-5260	10%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20151228, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170013292, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 30% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), XXXXXXXXXXXXXXXXXXX.

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

Sincerely,					      
Enclosure