RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX  	CASE:  PD-2017-02907
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071116

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Food Service Specialist, medically separated for “chronic low back pain” with a disability rating of 10%.   

CI CONTENTION:  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 - 20070814	VARD - 20080430	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Lumbar Degenerative Disc Disease 	5243	20%	20070827	
Neck and Upper Back	Not Unfitting	Cervical Spondylosis	5242	20%	20070827	
Bilateral Knee Pain	Not Unfitting	Right Knee Retropatellar Pain Syndrome	5299-5014	10%	20070827	
		Left Knee Retropatellar Pain Syndrome	5299-5014	10%	20070827	
Bilateral Pes Planus	Not Unfitting	Bilateral Pes Planus	5276	NSC	20070827	
Bilateral Wrist Pain	Not Unfitting	Left Wrist Tenosynovitis	5299-5024	10%	20070827	
		Right Wrist Tenosynovitis	5299-5024	10%	20070827	
Intermittent Shin Splints	Not Unfitting	No VA Placement	
Hypertriglyceridemia	Not Unfitting	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Low Back Pain (LBP).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in 2002 after falling.  In July 2006 the LBP acutely increased.  X-rays in showed slight narrowing at L5-S1.  An MRI showed degenerative disk disease at L4-5 and L5-S1 with small disk protrusions, but the spine surgeon determined the CI was not a surgical candidate. 

During the 7 June 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported LBP with intermittent radiation to the hips.  Physical examination showed diffuse tenderness.  The range of motion (ROM) evaluation showed flexion of 60 degrees (normal 90).  The 25 June 2007 MEB NARSUM examination, 6 months prior to separation, noted complaints of 6-8/10 LBP.  Physical examination showed no palpable paraspinous muscle spasm and no significant paraspinous muscle tenderness to palpation bilaterally.  The goniometric ROM evaluation, after repetition, showed flexion of 30 degrees and combined ROM of 110 degrees (normal 240).  There was no muscle spasm and no significant paraspinal tenderness.  The examiner noted pain with examination maneuvers which would not be expected to elicit pain, based on the known pathology.  

At the 27 August 2007 VA Compensation and Pension (C&P) examination, 3 months before separation, the CI reported mild to moderate intermittent LBP.  Physical examination showed normal posture and gait.  The lumbar spine revealed mild to moderate lumbar curve reversal, but there was no evidence of spasm or guarding.  The thoracic spine was within normal limits, but the CI complained of a dull ache in the thoracic and the paraspinal muscles.  Scapulocostal (also known as scapulothoracic joint) function was normal.  The ROM evaluation, after repetition, showed flexion of 65 degrees and combined ROM of 180 degrees, with painful motion.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5237 (lumbar spine strain), citing tenderness and flexion limited to 48 degrees.  The VA rated the back condition 20%, coded 5243 (intervertebral disc syndrome), based on the C&P examination, citing muscle spasms or guarding severe enough to result in an abnormal spinal contour such as reversed lordosis.  

The panel considered the somewhat disparate examination and the panel majority placed greater probative value on the pre-separation C&P examination that was at least as thorough as the other examinations, but was closer to the date of separation.  The panel majority agreed that a 10% rating, but no higher, was justified for limitation of flexion greater than 30 degrees but not greater than 60 degrees, as reported on the VA examination.  There was a finding of reversed lordosis but there were no corroborated objective findings of significant spasm or guarding on physical examination that could be considered causative.  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 majority concluded there was insufficient cause to recommend a change in the PEB adjudication for the back condition.  

Contended PEB Conditions:  Neck and Upper Back, Bilateral Knee, Bilateral Pes Planus, Intermittent Shin Splints, Mild Hypertriglyceridemia and Bilateral Wrist.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  None of the conditions were profiled, implicated in the commander’s statement or judged to fail 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 back condition and IAW VASRD §4.71a, the panel majority recommends no change in the PEB adjudication.  The single voter for dissent recommends re-characterization but did not elect to submit a minority opinion.  In the matter of the contended neck and upper back, bilateral knee, bilateral pes planus, intermittent shin splints, mild hypertriglyceridemia and bilateral wrist 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 20170425, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180015206, 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.