RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2017-03067
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20090927

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, AH-64D Armament/Electrical/Avionic System Repairer, medically separated for “intervertebral disc syndrome” with a disability rating of 10%.    

CI CONTENTION:  Requested review of the back condition as well as additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 - 20090709	VARD - 20091130	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Intervertebral Disc Syndrome	5243	10%	Degenerative Disc Disease, Lumbar Spine with Bilateral Lower Extremity Radiculopathy	5243	20%	20090929	
Mild Anterior Bilateral Knee Pain 	Not Unfitting	Right Knee Patellofemoral Syndrome	5260	10%	20090929	
		Left Knee Patellofemoral Syndrome	5260	0%	20090929	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Intervertebral Disc Syndrome (IVDS).  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition began about January 2008 without specific injury.  Radiograph imaging of the lumbar spine from June 2008 showed a small posterior disc bulge with endplate hypertrophy at the L1-L2 lumbar vertebrae levels.  There was no surgery.  
During the 24 June 2009 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI had a normal gait and spinal contour, with no tenderness or spasms, and normal deep tendon reflexes, muscle strength, and sensation.  Radicular testing was negative, and range of motion (ROM) measurements revealed flexion to 70 degrees (normal 90) with moderate pain, and a combined ROM of 215 degrees (normal 240).  At a primary care evaluation, 2 months prior to separation, the CI reported low back pain, rated at 5-6/ 10, which radiated to the left groin and leg.  He also endorsed left lower extremity numbness and generalized weakness.  Physical examination showed full lumbar ROM with pain during forward flexion and extension.  

At the 29 September 2009 VA Compensation and Pension (C&P) examination, 5 days after separation, the CI reported constant, dull, aching pain radiating down the legs to the feet.  The examiner noted a normal gait with flexion was to 45 degrees and a combined ROM was 175 degrees.  Pain was noted on all maneuver endpoints with no additional ROM loss after repetition. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5243 (IVDS), citing limitation of motion.  The VA rated the back condition 20%, also coded 5243, based on the C&P examination, citing for forward flexion of the thoracolumbar spine.  The ROM values reported by the VA examiner (5 days after separation) were significantly worse than those reported by the MEB examiner (3 months before separation). There was no record of recurrent injury or other development in explanation of the more marked impairment reflected by the VA measurements.  While ROM limitations may have progressed over time, there was no evidence in the record from which to conclude that the severity at separation approached that portrayed by the VA measurements.  Panel members agreed that the MEB examination was more consistent with the STR, and therefore relied more heavily on those measurements.  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  MEB examination.  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.  The panel considered whether a higher rating (§4.7) was achieved by using the alternate rating formula based the CI’s IVDS, but there were no incapacitating episodes in the record requiring physician-prescribed bed rest to warrant consideration of 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:  Mild Anterior 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 intervertebral disc syndrome 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:

	PD-2017-03067

[AR NUMBER], XXXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXX

	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.

Enclosure

	PD-2017-03067