RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02364
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20051124

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Parachute Rigger and Electronic Intelligence Analyst, medically separated for “chronic back pain “ with a disability rating of 0%.

CI CONTENTION:  “Please 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 - 20050721	VARD - 20060125	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5237	0%	Lumbar Spine Degenerative Disc Disease L4-5… 	5243	10%	20051011	
Bilateral Knee Pain	Not Unfitting	Right Knee Patellar Tendonitis	5019	0%		
		Left Knee Condition	5257	NSC		
Status Post Left Shoulder Dislocation		Left Shoulder Rotator Cuff Impingement	5020	10%		
Chronic Cervical Spine Pain		Cervical Spine Strain	5237	10%		
Hypertension		Hypertension	7101	10%		
Hypercholesterolemia		No VA Placement	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  90%	

ANALYSIS SUMMARY:

Chronic Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in 1994 during basic training.  He was subsequently treated with non-steroidal anti-inflammatory drugs, muscle relaxants, chiropractic care, and physical therapy (PT) through 2005. 

The 19 May 2005 MEB orthopedic consultation, 6 months before separation, and 15 April 2005 MEB NARSUM examination, 7 months prior to separation, noted complaints of back pain.  Physical examinations showed flexion to 60 degrees (normal 90); painful motion was present. Combined ROM was incomplete.  During the 20 May 2005 MEB PT examination repetitive ROM was flexion to 70 degrees and combined ROM was 195 degrees; painful motion was present.

During the VA Compensation and Pension (C&P) general examination, 2 months before separation, the CI reported low back pain.  Physical examination showed a normal gait and posture.  There was no spinal tenderness or muscle spasm.  Flexion was 80 degrees and combined ROM was 160 degrees; painful motion was present.

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 passive ROM.  The VA rated the back 10%, coded 5243 (intervertebral disc syndrome (IVDS)), based on the C&P general examination, citing limitation of motion.  

The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) or combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the  MEB PT and VA examinations proximate to separation.  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 IVDS 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 10% for the chronic back condition, coded 5237.  

Contended PEB Conditions:  Bilateral Knee Pain, Status Post Left Shoulder Dislocation, Chronic Cervical Spine Pain, Hypertension, and Hypercholesterolemia.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  The contended conditions were not implicated in the commander’s statement or profiled proximate to separation.  Only the contended bilateral knee pain was judged to fail retention standards.  There was no performance-based evidence from the record that 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 contended conditions, so no additional disability ratings are recommended. 

BOARD FINDINGS:  In the matter of the back condition, the panel recommends a disability rating of 10%, coded 5237 IAW VASRD §4.71a.  In the matter of the contended bilateral knee pain, status post left shoulder dislocation, chronic cervical spine pain, hypertension, and hypercholesterolemia, 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	
Chronic Back Pain	5237	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170302, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180011270, 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