RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01362
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060112

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E7, Financial Management Technician, medically separated for “chronic low back pain” with a disability rating of 0%.  

CI CONTENTION:  Additional not unfitting conditions and current condition supports a higher rating.  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 (VA), 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 - 20051007	VARD - 20070226	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Non-Radiating Low Back Pain	5299-5237	0%	Degenerative Disc/Degenerative Joint Disease, Lumbar Spine	5242-5243	10%	STR	
Right Knee Retropatellar Pain	Not Unfitting	Patellofemoral Syndrome, Right Knee	5099-5014	10%	STR	
Left Ankle Pain S/P Sprain	Not Unfitting 
	Left Ankle Strain	5299-5271	0%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Non-Radiating Low Back Pain (LBP).  According to service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s LBP condition began in 1992 without antecedent trauma or injury.  He was treated with medications, physical therapy, and duty limitations.  On 5 May 2000, x-ray studies showed no fracture or subluxation, but narrowing of L5-S1 disk with degenerative changes.  On 6 October 2001, an MRI of the lumbar spine showed L5-S1 degenerative disc disease without herniation.  A 25 January 2001 physical therapy evaluation showed a gradual increase in L5-S1 LBP.  The CI was continued on profile, but with increasing LBP causing decreased ability to perform military duties.  There was concern that he was not deployable.  He was then issued an L3 profile on 17 August 2005 and entered into the MEB process.  

The 21 September 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of daily pain that increased with standing, carrying, and lifting.  The physical examination showed normal walk, heel-toe, jogging, and jumping.  The back was held stiff with a decreased lordotic curvature.  No grimace on activity was noted.  Spinal range of motion (ROM) showed flexion 110 degrees (normal 90), extension 20 degrees (normal 30), side bending bilateral 40 degrees (normal 30), and rotation bilateral 75 degrees (normal 30).  Painful motion was not recorded.  Provocative testing for nerve root irritation was negative.  Deep knee bends were 85 degrees.  

At the 3 November 2006 VA Compensation and Pension (C&P) evaluation, 10 months after separation, the CI reported daily LBP.  The physical examination showed normal gait, normal musculoskeletal, and no strength deficits.  The ROM showed flexion 75 degrees, with pain starting at 50 degrees; extension 20 degrees, with pain starting at 15 degrees; right lateral bending 30 degrees with pain starting at 30 degrees; left lateral bending 20 degrees with pain starting at 20 degrees; right rotation 30 degrees with pain starting at 30 degrees; and left rotation 30 degrees with pain starting at 30 degrees.  The neurological examination was normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 0%, coded 5299-5237 (analogous to lumbosacral strain), citing no tenderness or spasm, no clinical signs of radiculopathy and full ROM.  The VA rated the back condition 10%, coded 5242-5243 (degenerative arthritis of the spine-intervertebral disc syndrome) citing painful or limited motion of a major joint.  The panel agreed that a 10% rating, coded 5237, was justified for limitation of motion demonstrated on multiple examinations.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  

Contended PEB Conditions:  Right Knee Retropatellar Pain, Left Ankle Pain S/P Sprain.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  Neither of the conditions was profiled at separation; however, the commander’s statement detailed that the LBP, right knee and left ankle prevented the CI from performing his duties.  The MEB Form 2808 only detailed the ROM for the knee at 90, 90, 85 degrees.  On the DD Form 2807-1, the CI reported the presence of back, knee, and ankle pain without further elaboration.  The NARSUM examiner found that these failed to meet retention standards, but the MEB determined that both conditions met retention standards.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for either of the contended conditions and no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the chronic LBP condition, the panel unanimously recommends a disability rating of 10%, coded 5237 IAW VASRD §4.71a.  In the matter of the contended right knee retro-patellar pain and left ankle pain s/p sprain conditions, the panel 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	
Chronic LBP	5237	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161003, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180001400, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

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