RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE: PD-2017-03078 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20080621

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Construction Equipment Operator, medically separated for “small disc herniation, left L5-S1,” and “chronic right hip pain,” rated 10% each, with a combined disability rating of 20%.

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 - 20080418	VARD - 20090116	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Disc Herniation, Left L5-S1	5243	10%	Herniated Disc, Lumbar Spine	5299-5243	0%	

STR	
Chronic Right Hip Pain	5099-5003	10%	Right Hip Condition	5250	NSC		
Patellofemoral Syndrome (PFS) Bilateral Knees	Not Unfitting	Pain, Right Knee	5260	0%		
		PFS, Left Knee	5299-5260	NSC		
Dyspepsia	Not Unfitting	GERD	7399-7346	NSC		
Cervicalgia	Not Unfitting	Cervicalgia	5299-5237	0%		
Astigmatism	Not Unfitting	Vision Problems	6066	NSC	20080716	
Myopia	Not Unfitting					
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 0%	

ANALYSIS SUMMARY:

Small Disc Herniation, Left L5-S1. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition began in December 2007 after wearing body armor. The 8 April 2008 MEB NARSUM examination, 2 months prior to separation, noted complaints of back pain which worsened after prolonged sitting. Physical examination showed normal gait and spinal contour. Thoracolumbar range of motion (ROM) testing showed flexion of 70 degrees and combined ROM of 135 degrees (normal 240) with pain in all planes of motion.

At the 8 January 2009 VA Compensation and Pension (C&P) examination, 7 months after separation, the CI reported constant lower back pain. Thoracolumbar ROM testing showed flexion of 80 degrees and combined ROM of 230 degrees with pain in all planes of motion.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the back condition 10%, coded 5243 (intervertebral disc syndrome (IVDS)), citing tenderness, limitation of flexion and limitation of combined ROM. The VA rated the back condition 0%, analogously coded 5299-5243, based on the STR, citing insufficient evidence of record to determine possible entitlement to a higher disability evaluation. 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 NARSUM and VA examinations. 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 IVDS 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.

Chronic Right Hip Pain. According to the STR and MEB NARSUM, the CI underwent arthroscopy right hip surgery with labral debridement in November 2006. The CI sustained a fall in January 2007 and was diagnosed with trochanteric bursitis. The 30 January 2008 physical therapy ROM study, 5 months prior to separation, showed flexion of 91 degrees (normal 125), extension of 17 degrees (normal 20) and abduction of 13 degrees (normal 45). During the MEB NARSUM examination the CI complained of right hip pain, made worse with walking, driving and operating heavy equipment. Physical examination showed right hip tenderness, pain-limited motion and decreased abduction with repetitive motion.

At the VA Compensation and Pension (C&P) examination, the CI reported constant pain and stiffness in the right hip. Physical examination showed a normal gait without tenderness, weakness, guarding or abnormal motion. The ROM evaluation showed flexion of 75 degrees, extension of 20 degrees and abduction of 15 degrees with pain in all planes of motion.

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 (arthritis, degenerative), citing periarticular pathology with limitation of motion. The VA did not rate the right hip condition, but rather found it to be not service compensation (NSC), coded 5250 (hip, ankylosis of), based on the STR, citing insufficient evidence of record to establish service connection. There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5252, 5251). However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45). There was no fracture, nonunion or malunion of the femur to support consideration under the code for hip impairment related to long bone conditions (5255). There was therefore no VASRD §4.71a rating higher than the 10% adjudicated by the PEB under any applicable code.  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 right hip condition.

Contended PEB Conditions: Chronic Postoperative Pain Right Knee, Patellofemoral Syndrome Left Knee, Dyspepsia, Cervicalgia, Astigmatism, and Myopia. The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting. The dyspepsia, cervicalgia, astigmatism and myopia conditions were not profiled, implicated in the commander’s statement or judged to fail retention standards. Although the MEB judged the left and right knee conditions to fail retention standards and “patellar tendonitis” was permanently profiled, panel members noted that neither knee was implicated in the commander’s statement. Furthermore, the focused examination of the knees on 18 March 2008 found no tenderness, crepitus or instability, and there was full ROM of each knee after repetition. The examiner also noted that fatigue, weakness, lack of endurance and incoordination did not appear to significantly limit functional ability. Therefore, the panel agreed, 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 determinations 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 recommends no change in the PEB adjudication. In the matter of the right hip condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the contended right and left knee pain, dyspepsia, cervicalgia, astigmatism and myopia, 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:

[AR NUMBER], 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.

Enclosure