RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02381
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081103

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E7, Intelligence Analyst, medically separated for “low back pain (LBP)” with a disability rating of 10%.  

CI CONTENTION:  “Review all conditions.”  Review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB) was also requested.  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 – 20080721	VARD - 20090929	
Condition	Code	Rating	Condition	Code	Rating	Exam	
LBP…	5243	10%	Lumbar Spine Degenerative Joint and DDD…	5243-5242	10%	20090625	
Post Traumatic Arthritis, Right Thumb	Not Unfitting 	Arthritis Right Thumb	5224	NSC	20090625	
Panic Disorder without Agoraphobia	Not Unfitting	Major Depression, Anxiety with Agoraphobia, OCD	9413-9434	50%	20090706	
Left Hip Tendinopahty	Not Unfitting	Tendonitis, Left Hip	5099-5019	10%	20090625	
Left Hip Myofascial Pain	Not Unfitting					
Paroxysmal Tachycardia	Not Unfitting	Sinus Tachycardia	7099-7010	0%	20090625	
Cervical Dysplasia	Not Unfitting	Cervical Dysplasia, Resolved	7612	NSC	20090610	
Recurrent Cystitus	Not Unfitting	Chronic Recurrent Cystitis	7512	10%	20090625	
Recurrent Shingles	Not Unfitting	Shingles, Left Forehead…	7899-7806	0%	20090625	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

LBP.  According to the service treatment record and MEB narrative summary (NARSUM), the CI noted a gradual onset of intermittent back pain beginning in March 1998 after a 25K ruck march.  In June 1998 the CI fell 8 feet off a balcony causing worsening and more frequent exacerbations of her LBP.  An MRI in June 2004 showed L5-S1 disc protrusion and degenerative disc disease (DDD).  The CI underwent epidural corticosteroid injections, chiropractic care, traction, physical therapy and a trial of TENS unit treatment without lasting improvement.  

The 20 June 2008 MEB NARSUM examination, 4 months prior to separation, noted complaints of constant LBP described as a dull throbbing ache with pinching in the left lower back.  Pain levels ranged from 5- 9/10.  Physical examination showed marked tenderness to palpation over the bilateral lumbosacral paraspinal musculature and moderated muscle spasm was noted in the lower lumbosacral spine paraspinal musculature.  There was no muscle atrophy, gait disturbance or voluntary guarding.  Range of motion (ROM) of the thoracolumbar spine after three repetitions showed flexion of 85 degrees (normal 90) with painful motion.  

At the 25 June 2009 VA Compensation and Pension (C&P) examination, 8 months after separation, the CI reported worsening daily back pain.  Physical examination showed a normal posture and gait.  Thoracolumbar spine ROM showed flexion of 65 degrees and a combined ROM of 185 degrees (normal 240) with objective evidence of painful motion.  There was no additional limitation after repetition.  The CI denied any incapacitating episodes.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5243 (intervertebral disc syndrome [IVDS]), citing forward flexion of 87 degrees and combined ROM of 207 degrees.  The VA also rated the back condition 10%, analogously coded 5243-5242 (IVDS-degenerative arthritis of the spine), based on the C&P examination, citing flexion of 65 degrees and combined ROM of 185 degrees.  

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) and combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the NARSUM and VA C&P 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 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 concluded there was insufficient cause to recommend a change in the PEB adjudication for the back condition.  

Contended PEB Conditions:  Right Thumb, Panic Disorder Without Agoraphobia, Left Hip Tendinopathy, Left Hip Myofascial Pain, Paroxysmal Tachycardia, Cervical Dysplasia, Recurrent Cystitis, and Recurrent Shingles.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  The 13 May 2008 psychiatric examination stated she met retention standards from a psychiatric perspective.  None of the conditions were profiled or implicated in the commander’s statement and none failed 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 low back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the right thumb, panic disorder without agoraphobia, left hip tendinopathy, left hip myofascial pain, paroxysmal tachycardia, cervical dysplasia, recurrent cystitis and recurrent shingles contended 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 20170226, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Record  

AR20190007870, 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