RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01896
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081203

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Cannon Crewmember, medically separated for “chronic low back pain” with a disability rating of 20%.  

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 - 20080826	VARD - 20090123	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	20%	Osteoarthopathy at the ACJ, Right Shoulder and DDD Lumbar Spine	5003	10%	20081002	
Occasional Right Shoulder Pain	Not Unfitting					
Anxiety Disorder	Not Unfitting	PTSD	9411	30%	20081006	
Occasional Right Knee Pain	Not Unfitting	Right Knee Condition	5260	NSC	20081002	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  70% 	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP).  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s low back condition began in September 2006 after his vehicle was hit by an IED blast.  His pain persisted despite initial treatment with medications and duty limitations.  An X-ray on 13 December 2006 was normal, but an MRI on 22 March 2007 showed degenerative disc disease (DDD) at L4-5 and L5-S1 with crowding of the L5 nerve roots.  He was also treated with physical therapy and injections, but he was unable to return to full duty.  

During the 11 June 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported persistent LBP.  The physical examination showed a normal gait and neurological examination.  Motion was painful and tenderness present.  Range of motion (ROM) measurements in physical therapy showed flexion of 40 degrees (normal 90) and a combined ROM of 130 degrees (normal 240).  

The 2 July 2008 MEB NARSUM examination, 5 months prior to separation, noted complaints of ongoing LBP.  The physical examination showed tenderness.  The gait was normal, as was the neurological examination with the exception of the distal musculature, which was noted to be 3/5.  The panel observed that the same examiner recorded 5/5 strength 1 month earlier and on previous examinations.  It was also noted that the CI could stand on his toes and heels.  The panel noted that 3/5 strength is not consistent with that capability or with a normal gait.  Panel members agreed this was most likely a typographical error and not indicative of actual motor loss.  

At the 2 October 2008 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported continued LBP which impaired activity.  The physical examination showed normal ROM, which was pain free.  Tenderness and spasm were absent.  He was noted to walk with a “stick,” but did not need it for ambulation.  The examiner commented that there was a disparity in function observed between that directly measured and observed in changing position, undressing, etc.  The level of function was less on direct observation than seen in routine activity (when the CI was not aware he was being assessed).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 20%, coded 5237 (lumbosacral strain), citing forward flexion of 40 degrees.  The VA combined the shoulder and spine condition at 10%, coded 5003 (arthritis, degenerative), based on the STR and C&P examination, citing osteoarthropathy of multiple joints in the absence of painful or limited motion.  The panel observed that the ROM measurements obtained by physical therapy for the MEB supported a 20% rating.  The remainder of the record supported no more than a 10% rating.  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 chronic low back condition.  

Contended PEB Conditions:  Occasional Right Shoulder Pain, Anxiety Disorder, and Occasional Right Knee Pain.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement.  All were found to meet retention standards.  There was no performance-based evidence from the record that any of the conditions 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 any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the chronic low back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended occasional right shoulder pain, anxiety disorder, and occasional right knee pain conditions, the panel recommends no change from the PEB determinations 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 20170313, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record  

AR20180008650, 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