RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-00382
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060914

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Wheeled Vehicle Mechanic, medically separated for “chronic back pain due to lumbar degenerative disc disease, without neurologic abnormality ” with a disability rating of 10%.  

CI CONTENTION:  He was not granted a rating for known service-connected injuries and also requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the MEB, but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20060727	VARD - 20061222	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain Due… 	5299-5242	10%	Lumbosacral Strain with Lumbar Degenerative Disc Disease	5242	20%	20060907	
Bilateral Retropatellar Knee Pain Syndrome	Not Unfitting	Left Knee Patellofemoral Pain Syndrome	5024	10%	20060907	
		Right Knee Patellofemoral Pain Syndrome	5024	10%	20060907	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Chronic Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back condition began in 2001 with no specific injury and gradually worsened.  There were scant treatment records available, but an MRI in August 2003 was reportedly normal (not in evidence) and X-rays in November 2002 showed muscle spasm, but were otherwise unremarkable.  The CI was seen in the emergency room in April and May 2006 with complaints of back pain, and in April he reported muscle spasms.   

During the 2 June 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported chronic back pain.  Physical examination revealed a normal gait and lumbosacral spine tenderness.  Lower extremity strength and reflexes were normal and straight leg raise (SLR) testing to elicit radicular symptoms was negative.  Physical therapy (PT) measured range of motion (ROM) for the MEB on the same day, and after three repetitions, thoracolumbar ROM was flexion of 30 degrees (normal 90) with a combined ROM of 110 degrees (normal 240).  Painful motion was noted.  

The 16 June 2006 MEB NARSUM examination noted CI complaints of constant low back pain with activity and aggravated by lying down, bending, stooping, lifting, twisting, or standing for prolonged periods of time.  He also had frequent muscle spasms when his back pain was severe.  On physical examination, he had difficulty when rising from a chair and had muscle spasms bilaterally.  Maneuvers to elicit radicular symptoms were negative, but did cause back pain.  Lower extremity strength, sensation, and reflexes were normal; ROM was not recorded.

At the 7 September 2006 VA Compensation and Pension (C&P) examination, 1 week before separation, the CI reported constant low back pain, but that he had not been placed on strict bed rest by a physician for incapacitating spine pain during the previous 12 months.  Physical examination showed normal posture and gait, and lumbar region tenderness.  Lower extremity strength and reflexes were normal bilaterally and SLR testing was negative.  Thoracolumbar ROM showed flexion of 40 degrees and combined ROM of 170 degrees, with painful motion.  There was no additional loss of ROM with repetitive movement.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, analogously coded as 5242 (degenerative arthritis of the spine), citing thoracolumbar ROM limited by pain, with muscle spasm.  The VA rated the low back condition 20%, also analogously coded as 5242, based on the C&P examination, citing flexion to 40 degrees.  The panel majority agreed that a 20% rating, but no higher, was supported for limitation of flexion (greater than 30 degrees but not greater than 60 degrees) as reported on the VA examination.  The panel noted that the limitation of thoracolumbar motion measured by PT for the MEB examination met the threshold for a 40% rating based on flexion of 30 degrees after repetition.  However, the VA examination was more proximate to separation and the panel majority placed greater probative value on its recommendation for a 20% disability rating at separation.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority recommends a disability rating of 20% for the low back condition, coded 5299-5242.  

Contended Condition:  Bilateral Retropatellar Knee Pain.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The commander’s statement dated 5 June 2006 implicated only the back condition as impairing the CI’s duty performance.  The 12 July 2006 MEB addendum for the knees noted a permanent profile for the bilateral knee condition since December 2002 with retention on active duty, and the examiner determined that the CI still met retention criteria for the condition.  The knee condition was not implicated in the commander’s statement nor did it fail retention standards, and there was no evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the chronic back pain, the panel majority recommends a disability rating of 20%, coded 5299-5242 IAW VASRD §4.71a.  The single voter for dissent recommends a disability rating of 40% and did not elect to submit a minority opinion.  In the matter of the bilateral retropatellar knee pain condition, the panel recommends no change from the PEB determination as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Back Pain	5299-5242	20%	

The following documentary evidence was considered:  

Exhibit A.  DD Form 294, dated 20170207, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Record  

AR20180014535  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.