RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00147
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050801

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Voice Intercept Operator, medically separated for “chronic back pain” rated 10%.

CI CONTENTION:  Additional unfitting conditions were not considered.  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 - 20050601	VARD - 20060807	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5299-5237	10%	DDD Lumbar Spine…	5243	10%	20060306	
Right Patellofemoral Knee Pain	Not Unfitting	Right Knee Chondromalacia Patella	5024	10%	20060306	
Migraine Headaches	Not Unfitting	Migraines	8100	NSC	20060524	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:

Chronic Back Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in August 2004 with no specific injury or trauma identified.  Radiographic studies performed in April 2005 showed degenerative disc disease and small disc herniation at L5-S1, with mild right and moderate left neuroforaminal stenosis.  There was no surgical indication, and conservative treatment did not alleviate the CI’s back symptoms.

The 5 May 2005 permanent profile listed lumbar spondylosis and right knee pain.  The commander’s statement implicated only the back condition as impairing the CI’s successful performance of the Army Physical Fitness test and/or the duties of his MOS.  

The 5 May 2005 MEB NARSUM examination, 3 months prior to separation, noted complaints of constant low back pain treated with narcotic (tramadol) and non-steroidal anti-inflammatory (ibuprofen) medications.  Physical examination reported lumbar tenderness.  Neurologic functioning was intact and provocative testing for lumbar nerve root irritation was negative.  Thoracolumbar-goniometric range of motion (ROM) was flexion to 90 degrees (normal 90) and combined ROM was 230 degrees (normal 240); painful motion was not addressed.  The MEB NARSUM examiner indicated the CI failed retention standards due to the back condition.  

At the time of the 14 June 2005 family practice clinic appointment, 2 months prior to separation, the CI reported low back pain that intermittently radiated to the back of the left thigh.  Physical examination revealed normal gait, stance and posture.  There was no tenderness or muscle spasm.  Thoracolumbar ROM was reported as full (measurements not cited) with painful motion.  Neurologic examination was normal, and provocative testing for nerve root impingement was negative.

At the 6 March 2006 VA Compensation and Pension (C&P) evaluation, performed 7 months after separation, the CI reported low back pain, exacerbated by sitting more than 2 hours, walking more than 2 miles or running more than ¼ mile.  The CI denied any periods of physician-prescribed bed rest during the previous 12 months.  Physical examination showed normal gait and spinal contour.  There was no tenderness or muscle spasm, and thoracolumbar ROM was flexion to 75 degrees and combined ROM was 180 degrees, with painful motion.  Neurologic examination was normal, and provocative testing for nerve root impingement was negative.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5299-5237 (lumbosacral strain), citing the presence of localized tenderness.  The VA also rated the back at 10%, coded 5243 (intervertebral disc syndrome), based on the C&P examination 7 months after separation, citing limitation of flexion.

The panel agreed a 10% rating was justified for the presence of painful motion reported at all examinations and tenderness as reported at the MEB NARSUM and C&P examinations.  The next higher rating of 20% was not justified for either limitation of flexion (greater than 30 degrees but not greater than 60 degrees) and/or combined ROM (not greater than 120 degrees) and/or muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour.  There was no evidence of intervertebral disc syndrome (IVDS) which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula (for IVDS).  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 chronic back pain.

Contended PEB Conditions:  Right Patellofemoral Knee Pain and Migraine Headaches.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  While knee pain was profiled, it was not implicated in the commander’s statement and was judged to not fail retention standards.  The migraine headache condition was not profiled or mentioned in the commander’s statement, and was also judged to not fail retention standards.  There was no performance-based evidence from the record that either 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 either of the contended conditions and so no additional disability ratings are recommended.  

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 contended right patellofemoral knee pain and migraine headaches, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There are 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 20160319, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record  

AR20170014075, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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