RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02458
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090212

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Artillery Mechanic, medically separated for “degenerative arthritis, lumbar spine,” with a disability rating of 20%.  

CI CONTENTION:  “My knee issues were never resolved, eventually had to have surgery, back issues have degraded with more symptoms.”  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 - 20081017	VARD - 20090623	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Arthritis, Lumbar Spine	5242	20%	Low Back Degenerative Disc Disease 	5237	10%	20090305	
Bilateral Knee Pain	Not Unfitting	Bilateral Knee Pain	5257	NSC	20090305	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Lumbar Spine Degenerative Arthritis.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began insidiously in November 2007 after working on a tactical vehicle.  An MRI revealed a disc herniation at T5-6 without significant stenosis or neural foraminal narrowing.  Conservative treatment was recommended.

During the 31 March 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 10 months prior to separation, the CI reported chronic low back pain.  Physical examination revealed a normal gait, paraspinal muscle tenderness, and decreased, painful flexion, extension and lateral flexion (range of motion (ROM) measurements were no quantified).  The 1 October 2008 MEB NARSUM examination, 4 months before separation, noted significant improvement of lower back pain and the CI was able to walk for longer periods of time.  However, he continued to have periodic persistent low back pain, rated at 7/10, with daily flare-ups to 9/10.  Physical examination showed tenderness, but a normal gait.  Thoracolumbar ROM testing, after repetition, showed flexion of 50 degrees (normal 90) and combined ROM of 175 degrees (normal 240).  Pain was elicited with motion.  

At the 5 March 2009 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported constant sharp stabbing pain in his lower back without radiation.  He denied any lower extremity numbness or weakness.  Physical examination showed normal thoracolumbar posture, but a wide-based, waddling gait.  Heel and toe walking was normal bilaterally, and there was tenderness from T11 to L3.  Thoracolumbar ROM testing showed flexion of 90 degrees and combined ROM of 210 degrees, with painful motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 20%, coded 5242 (degenerative arthritis of the spine), citing tenderness and forward flexion of 50 degrees.  The VA rated the back condition 10%, coded 5237 (lumbosacral strain), based on the C&P examination, citing tenderness and functional limitation due to pain.  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 MEB NARSUM examination.  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:  Bilateral Knee Pain.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement, and did not fail retention standards.  There was no performance-based evidence from the record that 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 back condition 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.  

The following documentary evidence was considered:  

Exhibit A.  DD Form 294, dated 20170307, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Record  

AR20190007848, 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