RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-01672
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20051118

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E7, Chemical Operations Specialist, medically separated for “arthritis both feet, both knees and left shoulder,” and “chronic low back pain,” rated 20% and 0%, respectively, with a combined disability rating of 20%.  

CI CONTENTION:  The CI made no specific contention.  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 - 20050930	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Arthritis Both Feet, Both Knees and Left Shoulder	5003	20%	No VA Examination Proximate to Separation in Evidence	
Chronic Low Back Pain	5237	0%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Arthritis Both Feet, Both Knees and Left Shoulder.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s feet and knees arthritis condition began in 2003 while his left shoulder condition began in 2004 without specific trauma or injury.  The STR records indicate these conditions were attributed to chronic arthritis of multiple joints.  

At the 29 June 2005 MEB NARSUM examination, 5 months prior to separation, the CI reported swelling in his feet with prolonged standing, and pain if he marched, ran, or jumped.  The CI also reported bilateral knee pain that had been diagnosed as arthritis.  The knee pain worsened if he walked, ran, jumped, or lifted over 20 pounds.  The CI reported pain in his left shoulder, arm, and hand accompanied by numbness.  Physical examination showed full range of motion (ROM) in all joints, and diffuse tenderness over multiple joints.  There was no VA examination in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The panel, per DoDI 6040.44, limited its focus to the decision made by the PEB in 2005.  The PEB rated the “arthritis both feet, both knees and left shoulder” condition 20%, coded 5003 (degenerative arthritis), citing two or more major joints with radiographic evidence and symptomatic.  Not uncommonly, this panel examines a rating applied to multiple body parts as an example of bundling, and subsequently examines each body part or condition to determine if it is separately unfitting and qualifies for a separate rating.  In this case, the panel noted the condition was arthritis of multiple joints, a single condition and not, as commonly encountered with bundled conditions, a constellation of distinct conditions brought together under a single rating.  IAW VASRD §4.71a, 5003 arthritis of multiple joints is rated 10% or 20% for two or more major joints, depending on the presence of incapacitating exacerbations, so long as there is not a deficit in the ROM for a joint included in the rating.  The panel noted that there was no documentation of occasional incapacitating exacerbations or limitations in ROM in the NARSUM or STR.  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 arthritis condition, coded 5003.  

Chronic Low Back Pain.  According to the STR and MEB NARSUM, the CI’s low back pain started in 2004 without specific injury.  At the 29 June 2005 MEB NARSUM examination the CI reported daily pain without radiation, numbness, or tingling.  The CI stated stretching his back improved the pain somewhat, but lifting over 20 pounds, walking, running, carrying a ruck sack, bending, or marching worsened his pain.  Physical examination showed full ROM with painful motion.  There was no tenderness and straight leg raise testing was negative.   

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 0%, coded 5237 (lumbosacral strain), citing degenerative disc disease and full ROM with pain.  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; however the NARSUM examination noted the presence of painful motion.  A 10% rating was therefore warranted.  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.  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 back condition, coded 5237.  

The panel observed that the combined rating from the arthritis and back conditions remained at 20%, providing no advantage to the CI.  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 arthritis and back conditions.  

BOARD FINDINGS:  In the matter of the arthritis condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the back condition and IAW VASRD §4.71a, 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 

AR20180005839, 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