RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX		CASE: PD-2017-02018 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20050217

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Health Care Specialist, medically separated for “low back pain” with a disability rating of 10%.

CI CONTENTION: “I did not receive a disability rating for my knee injury as well as for my back injury. The back injury/condition causes continued problems especially if on my feet for long periods of time.”  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 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 - 20041123	VARD - 20050407	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5237	10%	Lumbar Spine DDD	5242	20%	20041220	
[Right] Retropatellar Pain Syndrome	Not Unfitting	No VA Placement	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Low Back Pain. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in December 2001 with pain radiating into her right thigh and lower leg. An MRI of the lumbosacral spine in April 2004 was unremarkable, but X-rays showed minor degenerative disk changes. The CI was not considered a surgical candidate. A clinic visit on 9 June 2004, showed flexion of 90 degrees (normal) with mildly decreased strength of the right lower extremity (4/5). The 27 July 2004 MEB NARSUM examination, 7 months prior to separation, noted complaints of low back pain with intermittent radiculopathy. Physical examination showed the CI walked without an antalgic gait and had essentially good mobility of the entire spine. The examiner reported trunk flexion with fingers reaching to 35 cm (13.78 inches) from the floor, which approximates 70 degrees of thoracolumbar flexion. Thoracolumbar ROM measurements performed by physical therapy (PT), the same day, showed flexion of 50 degrees and combined ROM of 155 degrees, after repetition.

At the 20 December 2004 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported low back pain with radiculopathy in the right leg. Physical examination showed the CI’s posture and gait were normal with no kyphosis or scoliosis. There was no paraspinous muscle spasm or tenderness. Thoracolumbar ROM measurements showed flexion of 60 degrees and combined ROM of 195 degrees, after repetition. Painful motion was present.  The CI was able to walk on her toes and heels and also tandem walk.

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 tenderness. The VA rated the back condition 20%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing flexion of 60 degrees. The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees), as reported in the examinations most proximate to separation. 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 recommends a disability rating of 20% for the back condition, coded 5237.

Contended PEB Condition: Right Knee Pain. The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting. Although right leg pain was profiled and knee pain was implicated in the commander’s statement, the knee pain did not fail retention standards. There was no performance-based evidence from the record that the right knee 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 right knee condition, so no additional disability rating is recommended.

BOARD FINDINGS: In the matter of the back condition, the panel recommends a disability rating of 20%, coded 5237 IAW VASRD §4.71a. In the matter of the contended right 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.

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Back Pain	5237	20%	

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20170303, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

	

AR20190015708, XXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXX

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs. 

Sincerely,

Enclosure