RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02535
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070606

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Combat Engineer, medically separated for “degenerative disc disease [DDD] of the lumbosacral spine” and “early osteoarthritis of the right hip,” rated 10% each, with a combined disability rating of 20%.   

CI CONTENTION:  No specific contention was made.  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 - 20070224	VARD - 20080929	
Condition	Code	Rating	Condition	Code	Rating	Exam	
DDD of the Lumbosacral Spine	5243	10%	DDD, Lumbosacral Spine	5242	NSC	STR	
Early Osteoarthritis of the Right Hip	5099-5003	10%	Right Hip	5255	NSC	STR	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Lumbosacral Spine DDD.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s low back condition began in November 2005 when he fell off a ladder while painting.  Spine X-rays showed no fractures and he recovered over the next 4 months.  In April 2006, he entered active duty from the National Guard, and began to experience worsening back pain with running and increased activity.  Back X-ray studies showed anterior spurring of the inferior portion of the L5 vertebra.  At a chiropractic visit on 6 September 2006, 9 months prior to separation, the CI complained of chronic pain at rest and with activity.  Physical examination showed normal gait, stance and a positive Yeoman’s and quadrant test of both legs.   Lumbar spine range of motion (ROM) testing showed flexion to 50 degrees with pain, and the examiner noted that neurological findings supported the physical symptoms.  

During the 18 October 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 8 months before separation, the CI reported his back injury was worse, and pointed to the level of L4-5 as the site of pain.   The examiner recorded full but painful active lumbar spine ROM, but no pain with squatting, heel or toe walking, and no tenderness.  

The 17 March 2007 MEB NARSUM examination, 3 months prior to separation, noted CI complaints of constant, central low back pain with occasional radiation into the legs.   Conservative treatment had not been beneficial, but he was not taking any pain medication.  He was only able to walk 5-10 minutes before stopping due to pain, could not jump or jog, and had difficulty lifting his 2-month old baby.  A lumbosacral spine CT, dated 4 January 2007, showed diffuse moderate disc bulging at L5-S1, with the L5 nerve root on the right inseparable from the bulging disc; there was also mild disc bulging at L4-5.  Physical examination showed goniometrically measured ROM of the lumbosacral spine limited to 45 degrees by pain.  There was no VA examination proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the lumbosacral spine condition 10%, coded 5243 (intervertebral disc syndrome), citing tenderness and ROM limited by pain.  The VA did not service connect the lumbar spine condition based on STR evidence.  Members noted the PT and NARSUM examinations recorded “lumbar spine” and “lumbosacral spine” ROM, and not thoracolumbar ROM as specified by the VASRD (§4.71a, Plate V).  Normal isolated lumbar flexion is 60 degrees, the ROM measurements showed lumbar flexion ROM to 45 and 50 degrees.  Therefore, the panel agreed a 10% rating, but no higher, was justified for painful motion and functional loss (IAW VASRD 4.59 and 4.40).  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 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 lumbosacral spine condition.  

Right Hip Osteoarthritis.  According to the STR and MEB NARSUM, the CI’s right hip condition also began in November 2005 after the same accident described above.  Some of the pain resolved with time and treatment. Imaging showed bilateral superior acetabular sclerosis (tissue hardening) and slight decrease in the superior joint space.   

During the MEB examination, the CI reported right sacroiliac joint pain, and the examiner noted right hip pain.  The MEB NARSUM examination noted complaints of right hip pain about half the day, while the left hip was minimally symptomatic.  The CI could not run due to right hip pain, but was not taking pain medication.  Physical examination showed a normal gait, and right flexion was to 60 degrees with abduction to 35 degrees; all hip motion was limited by pain.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right hip condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing application of the US Army Physical Disability Agency pain policy.  The VA did not service connect the right hip condition based on STR evidence.  Members agreed there was no limitation of motion to support a 10% rating for the right hip based on VASRD §4.71a codes for loss of hip/thigh motion (5250 through 5253).  However, IAW VASRD §4.40, §4.45, and §4.59, a 10% rating is warranted when there is satisfactory evidence of functional limitation due to painful motion of a major joint as indicated by X-rays showing sclerosis.  After due deliberation, considering all of 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 right hip condition.  

BOARD FINDINGS:  In the matter of the lumbosacral spine condition and IAW VASRD §4.71, the panel recommends no change in the PEB adjudication.  In the matter of the right hip condition and IAW VASRD §4.71, the panel recommends no change in the PEB adjudication.  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 20170109, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190006043, 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.