RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01248
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080627

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Infantryman, medically separated for “degenerative arthritis of the spine” with a disability rating of 10%.  

CI CONTENTION:  His back and knee injuries have prevented him from running, jumping, or lifting heavy weights since leaving the Army.  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 -20080311	VARD - 20081020	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Arthritis of the Spine	5242	10%	Degenerative Disc Disease, Lumbar Spine	5242	0%	20080618	
Retropatellar Syndrome	Not Unfitting	Retropatellar Syndrome	5260	0%	20080618	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Degenerative Arthritis of the Spine (Lumbar).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in 2003 after his vehicle was struck by an IED.  During the 30 November 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, the CI reported back problems since 2003.  Physical examination revealed full active ROM without tenderness or spasm.  There was painful motion of the back with leg maneuvers.  At the 14 December 2007 physical medicine evaluation, 6 months prior to separation, the CI complained of low back pain.  The physician documented a normal gait and the CI was able to walk on toes and heel walk.  There was minimal low back tenderness.  Back range of motion (ROM) was flexion to 90 degrees (normal 90) and combined 220 degrees (normal 240).  X-rays and MRI in December 2007 documented multilevel lumbar spine degenerative changes without significant focal disk protrusion or stenosis.  The 14 January 2008 MEB NARSUM examination, 5 months prior to separation, noted complaints of chronic low back pain.  Physical examination detailed the above physical medicine and MEB examinations and indicated full active ROM with pain on extremes.  

At the 18 June 2008 VA Compensation and Pension (C&P) examination, 9 days before separation, the CI reported low back pain.  Physical examination showed a normal gait and posture.  There was no back tenderness or spasm.  ROM was flexion to 80 degrees with pain and combined 230 degrees.  The spine was not additionally limited by pain, fatigue; weakness, lack of endurance, or incoordination after repetitive use.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5242 (degenerative arthritis of the spine), citing painful motion.  The VA rated the low back condition 0%, coded 5242, based on the C&P examination, citing both limited ROM and a noncompensable evaluation.  

There was no limitation of thoracolumbar spine motion to support a 10% rating under the General Rating Formula for Diseases and Injuries of the Spine from the MEB examination; however, the physical medicine and VA evaluations documented limited motion supporting the 10% rating.  There was alternatively tenderness from the physical medicine examination or painful motion on the NARSUM summary of the MEB examination to support the 10% rating.  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/or combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the MEB and VA examinations respectively.  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.  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 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 low back condition.  

Contended PEB Condition:  Left Knee Pain Secondary to Retropatellar Pain Syndrome.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement, or 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.  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 low back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended left knee 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.  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 20170322, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180008616, 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.

Sincerely,					      
Enclosure