RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03250
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050213

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Automated Logistical Specialist, medically separated for “low back pain” and “right hip pain,” rated 0% each, with a combined disability rating of 0%.

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 - 20041201	VARD - 20050304	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5243	0%	Discogenic Disease, Lumbar Spine	5243	20%	20050107	
Chronic Right Hip Pain	5099-5003	0%	Trochanteric Bursitis, Synovitis, Post-Operative, Right Hip	5019-5020	10%	20050107	
			Residuals of Scar, Right Hip	7804	0%	20050107	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP):  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s LBP condition began approximately in 1998 without trauma or injury.  An MRI in 2003 showed L5/S1 degenerative disc disease; surgery was not indicated.  The 4 November 2004 MEB NARSUM examination, 3 months prior to separation, noted CI complaints of continued LBP pain with some radiation to the right foot.  Physical examination showed minimal difficulty with walking and no muscle spasm.  Range of motion (ROM) testing showed flexion to 60 degrees (normal 90) and a combined ROM of 200 degrees (240 normal); painful motion was present.

At the 7 January 2005 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported daily LBP that became worse with walking, running, or laying down; pain could be rated at 10/10.  Physical examination revealed an antalgic gait, spinal tenderness and muscle spasms; posture was not addressed.  Flexion was 80 degrees and combined ROM was 180 degrees; painful motion was not addressed.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic LBP condition 0%, coded 5243 (intervertebral disc syndrome (IVDS)), citing limitation of motion due to pain and not mechanical (AR 635-40) origins.  The VA rated lumbar discogenic disease 20%, also coded 5243, based on the C&P examination, citing muscle spasm or guarding severe enough to result in an abnormal gait.  Members agreed that the MEB NARSUM ROM measurements supported a 20% rating based on limitation of flexion, while the VA examination also supported a 20% rating based on muscle spasm or guarding severe enough to result in an abnormal gait.  There was no documentation of IVDS with incapacitating episodes, proximate to separation, which would provide for a higher rating under that formula.  The panel noted there was no objective evidence of a radiculopathy with functional impairments (such as weakness) that significantly interfered with satisfactory duty performance at separation.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the LBP condition, coded 5999-5237 (lumbosacral strain).

Chronic Right Hip Pain.  According to the STR and MEB NARSUM, the CI’s right hip pain condition began in October 2003.  She had surgery for anterior synovitis and grade 2 chondromalacia of the central acetabulum in July 2004, but still had pain postoperatively.  The MEB NARSUM examination noted CI complaints of persistent right hip pain.  Physical examination showed right hip external rotation to 20 degrees (normal 45), flexion to 110 degrees (normal 125), and extension to 10 degrees (normal 20); painful motion was present.

At the C&P examination, the CI reported daily right hip pain worsened by walking or laying on the right side.  Physical examination revealed right hip external rotation to 45 degrees, flexion to 125 degrees, extension to 0 degrees, and abduction to 45 degrees (normal); tenderness was present with ROM testing, but painful motion was not specifically addressed.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right hip condition 0%, analogously coded 5099-5003 (arthritis, degenerative), citing pain limited hip function.  The VA rated the right hip condition 10%, dual coded 5019-5020 (bursitis-synovitis) based on the C&P examination, citing functional loss due to pain.  Members agreed there was no limitation of flexion, extension, abduction, adduction or rotation supporting a rating under VASRD diagnostic codes 5251, 5252 or 5253.    Additionally, there was no hip flail joint; or impairment of the femur with fracture of shaft or anatomical neck with nonunion; or fracture of the surgical neck with a false joint, or malunion with slight knee or hip disability to justify ratings under codes 5254 or 5255.  However, there was sufficient STR evidence of painful motion with functional loss to support a 10% rating IAW §4.59, §4.40 and §4.45.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right hip pain condition, coded 5099-5003.

BOARD FINDINGS:  In the matter of the chronic low back pain condition, the panel recommends a disability rating of 20%, coded 5299-5237 IAW VASRD §4.71a.  In the matter of the chronic right hip pain condition, the panel recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.

The panel recommends the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Low Back Pain	5299-5237	20%	
Chronic Right Hip Pain	5099-5003	10%	
COMBINED	30%	

The following documentary evidence was considered:  

Exhibit A.  DD Form 294, dated 20170426, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180009597, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 30% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), XXXXXXXXXXXXXXXXXX.

	A copy of this decision has also been provided to the Department of Veterans Affairs 

Sincerely,					      
Enclosure