RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00710
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20051029

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

CI CONTENTION:  The rating should be higher.  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 - 20050728	VARD - 20051116	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain 	5243	10%	DDD, Lumbar Spine	5243	20%	20050817	
Chronic Right Shoulder Pain	5201	0%	Surgical Repair, Right Shoulder	5203	10%	20050817	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Low Back Pain (LBP) Secondary to Degenerative Disc Disease (DDD).  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition began in 2004 without any specific injury or trauma.  Diagnostic imaging (MRI) in 2004 showed multilevel DDD and small disc protrusions at L4-5 and L5-S1 with no central stenosis and varying degrees of neuroforaminal narrowing.  He was seen in neurosurgery on 15 September 2005 and had a computed tomography scan and a myelogram done that showed no focal disc protrusion or canal stenosis.  There were no neural compressive lesions identified.  Electrodiagnostic testing on 22 February 2005 was abnormal with evidence of L5-S1 radiculopathy versus sacral plexopathy.  The CI elected non-surgical treatment.  

The 12 May 2005 MEB NARSUM examination, 5 months prior to separation, noted complaints of daily 8/10 LBP in the morning.  The condition was aggravated by exertion, strenuous activities, bending or prolonged standing.  A lumbar spine series revealed L5-S1 disc space narrowing.  Physical examination showed a normal gait, but there was tenderness.  Provocative testing for radicular signs was positive on the left.  Strength and reflexes were normal.  Range of motion (ROM) testing by physical therapy on 5 May 2005 showed 20 degrees of flexion (normal 90) and combined ROM of 110 degrees with pain on motion.  

At the 17 August 2005 VA Compensation and Pension (C&P) evaluation, 2 months before separation, the CI reported constant back pain that traveled to the left leg.  He related 10 incapacitating episodes over the previous year for a total of 20 days and noted 10 days with some work loss due to pain over the previous year.  Physical examination documented the CI’s posture and gait as abnormal with a pelvic tilt favoring the lumbar spine.  Physical examination recorded no complaints of radiating pain on movement.  There was no muscle spasm or tenderness noted.  Straight leg raise testing was a positive on both legs.  There was flexion of 60 degrees and combined ROM of 170 degrees with painful motion.  There were no signs of intervertebral disc syndrome (IVDS) with chronic and permanent nerve root involvement.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5243 (IVDS), citing tenderness.  The VA rated the back condition 20%, coded 5243, based on the C&P examination, citing the 20% rating criteria.  Spine ratings IAW VASRD criteria are based on active ROM and not passive ROM as cited by the PEB.  The VA examination was closest to, and prior to, separation and carried the highest probative value for rating at separation.  

The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees), as reported on the VA examination.  There was no documentation of IVDS 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 recommends a disability rating of 20% for the back condition, coded 5243.  

Chronic Right Shoulder Pain.  According to the STR and MEB NARSUM, the right-hand dominant CI underwent right shoulder surgery on 13 December 2004 for a partial labral tear.  According to the 12 May 2005 MEB NARSUM evaluation, 5 months prior to separation, the CI complained of daily 5-6/10 right shoulder pain.  He noted that stretching and medications lowered the pain during the day.  Pain was aggravated by any strenuous activity.  Physical examination revealed tenderness in the bicipital and subacromial areas.  There was normal sensation and strength with no atrophy.  There was slight limitation of movement with associated pain in all movements.  The examiner did not note guarding, swelling, effusion, crepitus or instability.  ROM testing showed flexion of 120 degrees (normal 180) and abduction of 80 degrees (normal 180) with pain.  

At the 17 August 2005 C&P examination, 2 months before separation, the CI reported constant right shoulder pain without incapacitation, limited ROM and difficulty lifting heavy objects.  Physical examination showed a normal appearing shoulder.  ROM testing showed 130 degrees of flexion and 120 degrees of abduction, limited by pain.  There was no additional limitation by fatigue, weakness, lack of endurance or in-coordination after repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under the 5201 code (arm, limitation of motion of) citing pain-limited motion.  The VA assigned a 10% rating using code 5203 (clavicle or scapula, impairment of), citing painful and limited motion.  The VA examination was closest to, and prior to, separation and carried the highest probative value for rating at separation.  

The VASRD §4.71a threshold for rating for ROM impairment (code 5201, arm limitation of motion) is “at shoulder level” (approximately 90 degrees from the side), and the VA examination demonstrated motion above this level.  However, panel members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion) noted in all examinations proximate to separation.  There was no malunion or recurrent dislocation of the humerus and no dislocation or nonunion of the clavicle or scapula to justify a higher rating under the 5202 (humerus, other impairment of) or 5203 (clavicle or scapula, impairment of) codes.  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.  

BOARD FINDINGS:  In the matter of the back condition, the panel recommends a disability rating of 20%, coded 5243 IAW VASRD §4.71a.  In the matter of the right shoulder condition, the panel recommends a disability rating of 10%, coded 5203 IAW VASRD §4.71a.  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; 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	
Low Back Pain 	5243	20%	
Chronic Right Shoulder Pain	5203	10%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170222, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment

AR20180004753, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

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), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557.

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

Sincerely,					      
Enclosure