RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01455
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060807

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E5, Light Wheeled Vehicle Mechanic, medically separated  for “chronic low back pain” and “left (non-dominant) rotator cuff tendonitis,” rated 10% and 0%, respectively, with a combined  disability rating of 10%.   

CI CONTENTION:  No specific contention was made.  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 - 20060605	VARD - 20070816	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5237	10%	Lumbosacral Strain	5295-5292	40%	20070712	
Left (Non-Dominant) Rotator Cuff Tendonitis	5099-5019	0%	Left Shoulder Tendonitis	5024	10%	20070712	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP).  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s chronic LBP began in October 1994 after changing a tire on a 5-ton truck.  No additional injuries or trauma were reported.  The back pain limited the CI from wearing body armor and thus a permanent profile was issued.  An orthopedic evaluation in January 2006 revealed full range of motion (ROM) of the lumbosacral spine. 

The 10 May 2006 MEB NARSUM examination, 3 months prior to separation, noted CI complaints of daily LBP with no radicular symptoms.  Physical examination (PE) revealed tenderness about the lumbar spine.  A physical therapy (PT) ROM evaluation performed on 18 May 2006 noted flexion of 70 degrees (normal 90) and combined ROM of 125 degrees (normal 240).

At the 12 July 2007 VA Compensation and Pension (C&P) examination, 12 months after separation, the CI reported increased LBP and decreased mobility over a 2-year period.  Flare-ups occurred weekly with intensity described as severe.  The PE revealed decreased and painful motion of the thoracolumbar spine, normal flexion and combined ROM of 150 degrees.  Guarding and local tenderness was present without spasm or surrounding atrophy, and gait was normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic low back condition 10%, analogously coded 5299-5237 (lumbosacral strain), citing local tenderness and a combined passive ROM of 245 degrees.  Utilizing the same primary code, the VA rated the low back condition 40%, citing, “that although the evidence of record shows the back condition had improved and would not warrant a 40 percent rating under current criteria…sustained improvement has not been established…” and proposed no reduction at the time of the VA Rating Decision dated 16 October 2007.  Members agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees or the combined ROM of greater than 120 degrees, but not greater than 235 degrees) as reported on the PT examination.  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 LBP condition.  

Left Shoulder Rotator Cuff Tendonitis.  According to the STR and MEB NARSUM, the CI had arthroscopic surgery on his left shoulder in 2003 and remained without pain until he started wearing body armor in October 2005 during mobility training.  There was no history of recurrent or direct injury to his shoulder, and despite local steroid injections, medications and PT, he was unable to finish mobilization training and was placed on a permanent profile.  A left shoulder X-ray in October 2005 was normal, and an MRI in December 2005 indicated signs of bursitis.  

The MEB NARSUM examination noted CI complaints of daily left shoulder pain that limited any type of overhead work or lifting greater than 10 pounds.  The PE revealed decreased ROM with abduction to approximately 130 degrees (normal 180) with no comment on painful motion. 

At the C&P examination, the CI reported left shoulder instability, stiffness and weakness.  The PE revealed painful and decreased ROM with flexion to 140 degrees (normal 180) and abduction to 125 degrees (normal 180).

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left rotator cuff tendonitis condition 0%, analogously coded 5099-5019 (bursitis), citing abduction at 130 degrees, inability to wear body armor, and permanent service aggravation.  The VA rated the left shoulder tendonitis condition 10%, coded 5024 (tenosynovitis), based on the C&P examination, citing painful or limited motion of a major joint or group of minor joints. Members first agreed that the NARSUM examination carried the greatest degree of probative value as it was most proximate to 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 ROM measurements demonstrated motion above this level.  Additionally, there was no evidence of painful motion to support a minimum 10% rating under VASRD §4.59 (painful motion).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left shoulder rotator cuff tendonitis condition.

BOARD FINDINGS:  In the matter of the chronic low back pain and IAW VASRD §4.71, the panel recommends no change in the PEB adjudication.  In the matter of the left shoulder rotator cuff tendonitis condition, the panel recommends no change in the PEB adjudication.  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 20170223, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180010083, 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