RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00643
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20050922

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E1, Patriot Operator/Maintainer, medically separated for “chronic low back pain” with a disability rating of 10%.  

CI CONTENTION:  “Please review all conditions.”  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 Medical Evaluation Board (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 - 20050729	VARD - 20060120	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Chronic Lumbosacral Strain	5243	10%	20051207	
Congenital Obstruction of the UPJ	Not Unfitting	UPJ Obstruction	7599-7501	0%	20051207	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP).  The first record in evidence specific for the LBP was an emergency room triage note on 20 December 2004 which noted a 3 month history of LBP.  An MRI of the lumbar spine was normal, but an incidental finding of a partial uteropelvic junction (UPJ) obstruction, the junction between the ureter and kidney, was noted.  The 29 April 2005 orthopedic examination showed tenderness and spasm on the right lumbar region, but only minor restrictions in flexion.  It was thought that the pain was renal (kidney) in origin rather than from the back.  Possible stenosis of some of the nerve root openings was noted on the MRI.  

The same orthopedist prepared the MEB narrative summary examination, dated 10 June 2005, 3 months prior to separation.  The CI reported constant pain located between the waist and shoulder.  Activity aggravated it.  On examination, there was a 1 cm “hump” in the right paraspinal area of the upper lumbar spine that expanded to 1.5cm on forward bending, which the examiner stated was an asymmetry of the back that was not associated with scoliosis.  Tenderness and spasm were present.  The gait was normal.  The thoracolumbar range of motion (ROM) measurements showed, after repetition, flexion of 75 degrees (normal 90) and combined ROM of 220 degrees (normal 240) with no mention of painful motion.  The neurological examination was normal.  Electrodiagnostic testing of the right lower extremity on 19 July 2005 was normal.  He was seen in follow-up in physical medicine on 8 August 2005 and noted persistent pain.  The ROM, gait, and neurological examination were all normal.  The CI continued treatment with electrical stimulation in physical therapy up until separation.  This was beneficial.  The subsequent ROM and neurological examinations, when recorded, remained normal.  

At the 7 December 2005 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported constant pain without flare-ups which was aggravated if he bent over, tried to lift over 20 pounds or walked long distances.  He denied incapacitation.  The CI denied any incapacitating episodes in the past year.  The physical examination showed a slight limp (although the gait was noted to be normal), normal posture, and mild tenderness.  There was no muscle spasm.  Thoracolumbar ROM measurements showed flexion of 65 degrees and combined ROM of 150 degrees after repetition with painful motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5237 (lumbosacral strain), citing mild paraspinous spasm without spinal deformity, no radiculopathy and flexion of 74 degrees.  The VA rated the back condition 10%, coded 5243 (intervertebral disc syndrome), based on the C&P examination 3 months after separation, citing limited motion.  The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) and combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the MEB and VA examinations proximate to separation.  Although there was muscle spasm noted on the MEB examination, it was not severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the back condition.  

Contended PEB Condition:  Congenital Obstruction of the Ureteral Pelvic Junction.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  Although the contended condition was profiled and judged to fail retention standards, there was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  As noted in the history for the back condition above, there was an incidental finding of either mild right hydronephrosis (dilated kidney collecting system) or a partial UPJ obstruction.  A nuclear medicine study on 7 January 2005 confirmed the UPJ obstruction.  The CI was evaluated in urology 3 weeks later and was found to have a congenital UPJ obstruction.  This was then treated with a right ureteral stent on 9 March 2005 with resolution of the obstruction confirmed the next day by a second nuclear medicine study.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended UPJ obstruction, 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.  Therefore, the panel recommends 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 20170221, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180004724, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	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.

A copy of this decision has been provided to the counsel you listed on your application, XXXXXXXXXXXXXXXXXX

Sincerely,					      
Enclosure