RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02626
BRANCH OF SERVICE:  army	SEPARATION DATE:  20090730

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Automated Logistical Specialist, medically separated for “right sacroiliitis with associated L4-S1 degenerative disc disease” with a disability rating of 10%.

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 - 20090710	VARD – 20100108/20100407	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Sacroiliitis with…L4-S1 DDD	5242-5236	10%	Degenerative…Spine	5243	10%	20090413	
Chronic Pelvic Pain	Not Unfitting	Chronic Pelvic Pain…Bladder…	7517	0%	20091208	
Bladder Hyperactivity	Not Unfitting					
Hemorrhoids	Not Unfitting	Hemorrhoids	7336	0%	20090413	
Allergic Rhinitis	Not Unfitting	Allergic Rhinitis	6522	0%	20090413	
Headaches	Not Unfitting	Headache Syndrome…	8100	30%	20100315	
Non Specific…Brain Lesions	Not Unfitting					
Tibial Stress Fractures	Not Unfitting	Bilateral Leg Stress…	5299-5262	NSC	20090413	
Intermittent Cervicalgia	Not Unfitting	Cervicalgia	5237	0%	20090413	
Cervical Dysplasia	Not Unfitting	…Dysplasia of Cervix	7612	NSC	20091208	
Depression	Not Unfitting	Mood Disorder	9434	30%	20091208	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60% 	

ANALYSIS SUMMARY:

Right Sacroiliitis with Associated L4-S1 Degenerative Disc Disease (DDD).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right pelvic, back and thigh pain began in 2005 after no specific trauma or injury.  A pain management evaluation on 6 March 2008 to treat the conditions revealed primarily pelvic pain with lumbar spine tenderness.  A lumbosacral spine X-ray on the same day was normal.  An MRI 3 weeks later showed multilevel DDD without disc herniation or nerve impingement.  A neurology evaluation on 11 April 2008 noted a normal neurological examination and assessed right-sided sacroiliac arthritis.  The CI was referred to physical therapy and reported significant improvement during a neurological follow-up on 6 May 2008.  On 3 June 2008, right lower extremity nerve conduction and sensory nerve tests were normal as were X-rays of the sacroiliac joints (SIJs) on 6 June 2008.  A right hip MRI was also unremarkable. 

The CI’s squad leader statement, dated 4 December 2008, noted she was able to accomplish a 2-mile road march in combat uniform and boots with a 50-pound ruck sack, and showed “no signs of pain or exhaustion” during or after the road march.  Due to ongoing pelvic pain, the CI was referred for MEB.  

At the 13 April 2009 VA Compensation and Pension (C&P) evaluation, 3 months before separation, the CI reported back and SIJ pain.  Physical examination showed that both lumbar spine and bilateral hip range of motion (ROM) measurements were full and pain-free with no tenderness or spasm.  Neurological findings and gait were normal and X-rays were not repeated.

The 20 May 2009 MEB NARSUM examination, 2 months prior to separation, noted complaints of ongoing pelvic, right sacroiliitis, and L4-S1 DDD pain which had improved with treatment.  The physical examination showed lumbosacral tenderness and spasm, but a normal gait, stance, and appearance (implying a normal contour).  Neurological findings were also normal.  Thoracolumbar ROM was flexion to 85 degrees (normal 90) and combined ROM of 230 degrees (normal 240); painful motion was present.
	
The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right low back and sacroiliac condition 10%, coded 5242-5236 (degenerative arthritis of the spine-sacroiliac injury and weakness), citing tenderness.  The VA also rated the right-sided low back condition 10%, coded 5243 (intervertebral disc syndrome), based on the C&P evaluation, citing painful or limited thoracolumbar spine ROM.  Panel members agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees), as reported by the MEB NARSUM examination most 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 intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula.  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 sacroiliitis with associated L4-S1 DDD condition.

Contended PEB Conditions:  Chronic Pelvic Pain, Bladder Hyperactivity, Hemorrhoids, Allergic Rhinitis, Headaches, Non-Specific White Matter Brain Lesions, Tibial Stress Fractures, Intermittent Cervicalgia, Cervical Dysplasia and Depression.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  The chronic pelvic pain was included in the L3 profile.  Both chronic pelvic pain and bladder hyperactivity conditions were judged to fail retention standards.  None of the remaining contended conditions were profiled and all were judged to meet retention standards.  No duty limitations were cited in the commander’s statement other than the CI’s inability to perform sit ups, and cross training was recommended.  There was no performance-based evidence from the record that any of the contended conditions significantly interfered with satisfactory duty performance at separation.  The PEB specifically noted that the chronic pelvic pain and bladder hyperactivity conditions improved periodically when the CI performed exercises (Kegels, pelvic muscle contractions to strengthen pelvic muscles).  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 and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the right sacroiliitis with associated L4-S1 DDD condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended chronic pelvic pain, bladder hyperactivity, hemorrhoids, allergic rhinitis, headaches, non-specific white matter brain lesions, tibial stress fractures, intermittent cervicalgia, cervical dysplasia and depression 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 20170424, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180005993, 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