RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02059
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070530

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Cavalry Scout, medically separated for “lumbar strain with back pain” with a disability rating of 10%.  

CI CONTENTION:  “Back issue worst” and other issues were not looked at.  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 FPEB - 20070228	VARD - 20071113	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar Strain with Back Pain	5299-5237	10%	Degenerative Arthritis and Disc Disease of the Lumbar Spine	5242	10%	20070926	
Chronic Left Ankle Pain	Not Unfitting	Post Traumatic Arthritis… Left Ankle	5010-5271	10%	20070926	
Renal Cyst	Not Unfitting	Polycystic Kidney Disease with Hematuria, Proteinuria, Bilateral Kidneys	7512-7533	0%	20070926	
Bilateral Knee Pain	Not Unfitting	Patellofemoral Syndrome, Left Knee 	5299-5259	10%	20070926	
		Arthritis…Patellofemoral…Right Knee	5010-5260	10%	20070926	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Lumbar Strain with Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back condition began in June 2003 after a vehicle accident while deployed in Iraq.  Following the injury, he underwent extensive physical therapy, electrical stimulation, and ice therapy, and was prescribed muscle relaxants and nonsteroidal anti-inflammatory drugs.  In 2004 and 2006, MRIs documented multilevel thoracolumbar degenerative disc disease, and an orthopedic surgeon stated surgery would not return the CI to full duty status. 

During the 16 October 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, the CI reported low back pain (LBP), and the provider noted decreased active range of motion (ROM) with “minimal forward flexion.”  A primary care evaluation on 2 November 2005 recorded ROM with flexion to 60 degrees (normal 90), and a combined ROM of 195 degrees (normal 240).  

The 14 November 2006 MEB NARSUM examination, 6 months before separation, noted CI complaints of daily LBP pain rated at 7/10, and worsened by sitting or standing for prolonged periods.  He also experienced some pain at night, with spasms, as well as pain going down the right lower extremity to the toes and lateral calf.  Physical examination showed no spasm or abnormal spinal contour.  Goniometrically measured ROM was painful, with flexion to 60 degrees and a combined ROM of 125 degrees after repetition.  

At the 26 September 2007 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported constant LBP with flares, stiffness, and radiating pain.  Physical examination showed normal gait and posture, with no abnormal spinal contour.  There were no functional limitations on standing or walking, and no spasms, weakness, or postural/muscular abnormalities.  The provider recorded tenderness over the lower lumbar spinous processes, sacroiliac joint, and sciatic notch in the right buttock.  Measured ROM, without repetition, was painful, with flexion to 80 degrees and a combined ROM of 220 degrees.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, analogously coded 5299-5237 (lumbosacral strain), citing tenderness, no spasms or radiculopathy, and flexion limited to 60 degrees by pain.  The VA rated the low back condition 10%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing localized tenderness but no abnormal gait or spinal contour.  Members 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 on the primary care and NARSUM examinations.  While the CI may have experienced radiating pain from the back condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  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 evidence of intervertebral disc syndrome which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under that formula.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the low back condition, coded 5299-5237.  

Chronic Left Ankle Pain, Renal Cyst, Bilateral 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, implicated in the commander’s statement or judged to fail 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 lumbar strain with back pain condition, the panel recommends a disability rating of 20%, coded 5299-5237 IAW VASRD §4.71a.  In the matter of the contended chronic left ankle pain, renal cyst, and bilateral 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.  

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

CONDITION	VASRD CODE	PERMANENT RATING	
Lumbar Strain with Back Pain…	5299-5237	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170208, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear  XXXXXXXXXXXXXXXXXX

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