RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01443
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070216

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve O4, Combat Engineer Officer, medically separated for “chronic low back pain” and “chronic right knee pain,” rated 10% and 0%, respectively, with a combined disability rating of 10%.   

CI CONTENTION:  “Physical Evaluation Board rating given for chronic low back pain of 10% does not adequately address the physical disabilities, limitations, and constant chronic pain of the right knee and right shoulder which contributed to inability to perform assigned duties.”  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 - 20061109	VARD - 20070824	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Degenerative Disc Disease, Lumbar Spine	5242	10%	20070710	
Chronic Right Knee Pain	5099-5003	0%	Right Knee Condition	5299-5257	10%		
Chronic Right Shoulder Pain	Not Unfitting	Right Shoulder Condition	5003-5203	10%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition began in January 2003 after heavy lifting.  At the 17 July 2006 physical therapy (PT) appointment, 7 months prior to separation, the CI reported back pain rated at 2/10.  The examiner noted that a December 2005 MRI showed mild facet osteoarthrosis at L3-S1 and mild degenerative disc disease L5-S1.  Physical examination showed tenderness and stiffness, but straight leg raise (for radiculopathy) and scouring (for hip defects) tests were negative.  Thoracolumbar range of motion (ROM) tests revealed pain during flexion.  

The 27 September 2006 MEB NARSUM examination, 5 months before separation, noted CI complaints of low back pain radiating to the left foot.  Physical examination showed ROM measurements, after repetitive motion, with flexion of 75 degrees (normal 90), and a combined ROM of 210 degrees (normal 240), all limited by pain.  Strength, reflexes and sensation were all normal.  During the 18 December 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, the CI reported back pain with numbness in the left foot.  Physical examination showed a normal spine.  

At the 10 July 2007 VA Compensation and Pension (C&P) evaluation, 5 months after separation, the CI reported constant, dull pain rated at 3/10, with radiation into the right leg with prolonged sitting; he stated that his last flare-up was in November 2005.  Physical examination showed a normal gait, posture and spine curvature.  ROM measurements showed flexion of 90 degrees and a combined ROM of 230 degrees with no loss of motion after repetition.  There was no objective evidence of painful motion, spasm, weakness, tenderness or pain radiation into the lower extremities; neurological findings were normal.  

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 diffuse degenerative changes and localized tenderness.  The VA also rated the back condition 10%, coded 5242 (degenerative arthritis of the spine), citing limitation of combined range of 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 NARSUM and VA 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.  There was no evidence of intervertebral disc syndrome which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under that alternate VASRD 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 chronic low back pain condition.  

Chronic Right Knee Pain.  According to the STR and MEB NARSUM, the CI underwent right knee surgery in February 2006 for an osteochondral lesion.  At the 15 September 2006 orthopedic visit, 5 months prior to separation, the CI reported continued knee pain.  Physical examination revealed some tenderness to palpation and pain with patellar grind but no effusion.  Varus/valgus stress, Lachman’s and anterior drawer tests were negative for instability as well as McMurray’s testing for meniscal pathology.  Right knee flexion was to 140 degrees (normal) and extension to 0 degrees (normal).  The examiner noted normal knee X-ray studies.  

The 27 September 2006 MEB NARSUM, 6 months prior to separation, noted CI complaints of right knee pain.  Physical examination showed flexion to 125 degrees and extension to 3 degrees, with no pain limitation.  During the 18 December 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months before separation, the CI reported knee pain and physical examination showed normal lower extremities.  

At the 10 July 2007 C&P evaluation, 5 months after separation, the CI complained of constant right knee pain rated at 4/10.  Physical examination showed a normal gait, no ankylosis, and no inflammatory arthritis.  Flexion was to 140 degrees and extension to 0 degrees.  There was no objective evidence of painful motion, edema, effusion, instability, weakness, tenderness redness, heat, or abnormal movement.  Radiographic studies on 11 July 2007 showed no fracture, dislocation, joint effusion or other osseous abnormality.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, analogously coded 5003 (arthritis, degenerative), citing no mechanical limitation of motion, no instability, and normal imaging.  The VA rated the right knee condition 10%, analogously coded 5257 (knee, other impairment of), based on the C&P evaluation, citing painful motion.  Members agreed there was no evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  There likewise was no limitation of motion which attained a 10% rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), or history of surgery to remove a meniscus (5259) to support a rating under those codes.  There was no fracture, nonunion or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  No additional functional limitation was evidenced by the examinations.  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 chronic right knee pain condition.  

Contended PEB Condition:  Right Shoulder Pain.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was profiled and judged to fail retention standards by the MEB.  The commander’s letter stated that the CI had “difficulty performing tasks that require a wide range of movement or lifting with his right shoulder.”  Thus, there was evidence from the record that the condition significantly interfered with satisfactory duty performance at separation, and so an additional disability rating is recommended.  

The 10 April 2006 MEB NARSUM addendum, 10 months prior to separation, documented that the CI had a slightly limited right shoulder ROM with flexion to 160 degrees (normal 180) and no mention of pain.  The 27 September 2006 MEB NARSUM, 6 months before separation, noted complaints of intermittent right shoulder during the day with activity, particularly when lifting.  Physical examination showed flexion to 57 degrees and abduction to 74 degrees (180 normal), both limited by pain.  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 detailed MEB NARSUM examination demonstrated motion below this level.  After due deliberation, the panel agreed that the preponderance of the evidence with regard to the functional impairment of right shoulder pain favors its recommendation as an additionally unfitting condition for disability rating.  It is appropriately coded 5201 and meets the VASRD §4.71 criteria for a 20% rating.  

BOARD FINDINGS:  In the matter of the chronic low back pain condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the chronic right knee pain condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended right shoulder pain condition, the panel agrees that it was unfitting and recommends a disability rating of 20%, coded 5201 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	
Chronic Low Back Pain	5237	10%	
Chronic Right Knee Pain	5099-5003	0%	
Right Shoulder Pain	5201	20%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170228, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180004886, 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