RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01942
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070725

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Carpentry/Masonry Specialist, medically separated for “chronic low back pain” with a disability rating of 10%.  

CI CONTENTION:  Review requested of back and knee 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 - 20070607	VARD - 20070913	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Degenerative Disc Disease, Lumbar Spine	5242	0%	STR	
Chronic Bilateral Knee Pain	Not Unfitting	Bilateral Knee Disorder	5020	NSC	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0% 	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back pain began in December 2006 after falling.  While X-rays and a bone scan were negative, an MRI showed straightening of the spine with mild degenerative disc disease.  

During the 14 March 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported a pinched nerve that affected his left buttock and caused bilateral leg pain.  Physical examination showed tenderness, but no spasm, and the ability to heel-to-toe walk.  Neurological examination was within normal limits to include negative straight leg raise tests.  Range of motion (ROM) testing showed decreased thoracolumbar flexion to 80 degrees (normal 90) with pain.  No other measurements were recorded.  

At the 2 May 2007 MEB NARSUM examination, approximately 3 months prior to separation, the CI complained of chronic back pain, rated at 7/10, and aggravated by running or “speed” walking, jumping, impact activities, stairs, sit-ups, push-ups, sitting or standing for prolonged periods, repetitive bending or firing a weapon from the prone position.  The MEB examiner referred to the 27 March 2007 physical therapy goniometric ROM evaluation, which showed, after repetition, flexion of 80 degrees, with pain, and combined ROM of 220 degrees (normal 240), with pain on extension.  The orthopedic examination on 28 March 2007 showed tenderness and an antalgic gait, but lordosis was normal and there was no evidence of guarding.  Lower extremity motor strength, reflexes and sensation were normal, and straight leg raise testing was negative.  There was no VA examination proximate to separation in evidence.  

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 pain limited motion and tenderness.  The VA rated the back condition 0%, coded 5242 (degenerative arthritis of the spine), based on the STR, citing a non-compensable evaluation for flexion greater than 85 degrees and combined thoracolumbar ROM greater than 235 degrees.  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) and/or combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the MEB and NARSUM 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 documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula.  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 back condition.  

Contended PEB Condition:  Chronic Bilateral Knee Pain.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  Although the contended condition was implicated in the commander’s statement, it was not profiled or judged to fail retention standards and serial X-rays were negative.  The 16 August 2008 VA examination, 13 months after separation, showed a normal gait and the CI denied functional limitations on standing.  He reported he was limited to walking 1-3 miles, but this was because of his back condition and not his knees.  The CI denied knee instability, give-way, pain, stiffness, weakness, subluxation, dislocation, locking, effusion or inflammation.  There was no performance-based evidence from the record that showed the condition 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 the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the chronic back pain and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended bilateral knee condition, the panel recommends no change from the PEB determination 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.  

AR20180014713, 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.