RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01593
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070213

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 “chronic low back pain” with a disability rating of 10%. 

CI CONTENTION:  “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 - 20061114	VARD - 20070702	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5237	10%	Lumbar Strain with DDD	5243	0%	20070205	
Right Knee Pain	Not Unfitting	Right Knee Strain	5014	NSC	20070205	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI injured his back prior to enlistment in 1991 and again in 2003 during a vehicular rollover while deployed.  In May 2005, he began to develop more constant pain during a ruck march.  Imaging (serial X-rays, MRI) identified L1-S1 degenerative disc disease (DDD) without surgical indication.  Various STR entries documented grossly normal range of motion (ROM) and no entries indicated any significant ROM limitation.  One examiner (9 months before separation) recorded flexion to 80 degrees (normal 90) and extension to 10 degrees (normal 30).  These clinical entries contrasted sharply with ROM measurements for the MEB conducted by physical therapy (PT) on 14 August 2006.  These were recorded as flexion to 45 degrees with a combined ROM of 125 degrees (normal 240), specifying “pain limit” for each plane.  There was STR documentation of normal gait and spinal contour, with no contrary entries.  There was no STR documentation of incapacitating episodes.

The 15 August 2006 MEB NARSUM examination, 6 months before separation (a day after the PT ROM measurements), documented 4/10 back pain “made worse with jumping, bending and sudden impact.” The pain prohibited him from running, lifting more than 30 pounds or wearing armor.  The physical examination recorded a normal gait without noting tenderness, spasm or other abnormal findings.  The examiner documented flexion to “approximately 80 degrees,” extension to 20 degrees, and bilateral flexion to 30 degrees (normal).  

At the 5 February 2007 VA Compensation and Pension (C&P) examination, on the eve of separation, the CI reported constant 4/10 pain.  The examiner noted non-specific functional impairment of “limited activity” and specified the absence of incapacitating episodes.  The physical examination recorded a normal gait and spinal contour, and the absence of tenderness or spasm.  Measured ROM was normal in all planes and“not additionally limited by pain, fatigue, weakness, lack of endurance or incoordination after repetitive use.”  Additionally probative was a VA physical medicine consult on 8 May 2007, 3 months after separation.  This documented a normal gait and spinal contour.  ROM testing measured flexion to 75 degrees, extension to 20 degrees and bilateral flexion to 25 degrees.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5299-5237 (analogous to lumbosacral strain), citing tenderness and painful motion.  The VA rated the back condition 0%, coded 5243 (intervertebral disc syndrome), citing the absence of ROM limitation or other compensable findings.

The panel noted that with the exception of the 0% C&P measurements and the 45 degree PT ROM measurement, all of the ROM evidence in this case fell within the 10% criteria of the VASRD §4.71a spine formula.  Members agreed that the PT ROM evidence was insufficiently probative to justify a higher rating recommendation.  The therapist’s wording suggested that ROM entries may have reflected pain threshold more than full excursion, and the evidence was contrary to all other preceding and subsequent evidence.  

The panel thus agreed that a 10% rating, but no higher, was justified for limitation of flexion greater than 60 degrees but not greater than 85 degrees as reported by the majority of examiners.  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 incapacitating episodes which would provide for a higher rating under that alternate rating 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 of the lumbar condition.

Contended PEB Condition:  Right Knee Pain.  The panel’s main charge is to assess the fairness of the PEB’s determination that the condition was not unfitting.  There was no performance-based evidence from the record that it significantly interfered with satisfactory duty performance at separation.  The CI complained of right knee pain dating to a 2003 fall while deployed to Iraq.  Imaging (MRI) did not demonstrate significant pathology and there were no outpatient STR entries that indicated any significant clinical acuity.  The condition was not profiled, implicated in the commander’s statement or judged by the MEB to fail retention standards.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the right knee condition; thus, 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 right knee condition, the panel agrees that it cannot recommend it for additional disability rating.  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 20170224, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180007955, 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