RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03303
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070530

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Infantryman, medically separated for “chronic low back pain” with a disability rating of 10%.  

CI CONTENTION:  The CI requested review of the adjudication of the back, right knee, and cough conditions, but also requested review of an additional condition 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 - 20070405	VARD - 20070905	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Myofascial Lumbar Syndrome	5299-5014	10%	20070723	
Chronic Mild Cough	Not Unfitting	No VA Placement	
Chronic Right Knee Pain		Right Knee Patellofemoral Syndrome	5299-5014	10%	20070723	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP).  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s low back condition began while he was deployed in February 2006 after falling over a wall barrier.  Treated conservatively, his pain resolved only to return after carrying heavy weapon gear.  He continued to have back pain as well as occasional numbness and weakness in his legs.  Upon re-deployment, radiologic studies of the low back and hips were normal.  Manual manipulations did not help relieve his pain and orthopedics did not recommend a surgical option.  

During the 21 February 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported that when his back flared-up, his right leg developed a numbing sensation and he felt a tingling sensation go up and down his spine.  His physical examination (PE) showed no tenderness, but range of motion (ROM) testing noted flexion of 45 degrees with pain (normal 90) and extension of 0 degrees (normal 30).  The only other plane of motion tested was rotation; no numerical result was recorded, but the motion was non-painful.  

The 14 March 2007 MEB NARSUM examination, 2 months prior to separation, noted complaints of 5-6/10 LBP with normal activity, which radiated to the right side more than the left.  The CI denied radicular and or bowel/bladder symptoms.  His physical examination (PE) revealed painful and limited spinal ROM measuring forward flexion to 75 degrees and a combined ROM of 210 degrees (normal 240); these measurements were obtained on 6 March 2007.  There was no additional limitation following repetitive use, and incoordination, fatigue, weakness, or lack of endurance had no effect on the spine.  Tenderness and low back spasms were present.  There was no comment concerning gait or findings of abnormal spinal contour.  

At the 23 July 2007 VA Compensation and Pension (C&P) spine examination, 2 months after separation, the CI reported one episode of incapacitation in the last 12 months.  He also reported 6-7/10 back pain with stiffness.  He denied flare-ups, numbness, weakness, or bowel/bladder incontinence.  His PE noted spinal tenderness, but muscle strength, sensation, and reflexes were normal and there was no evidence of spasm.  The ROM study showed flexion of 90 degrees and combined ROM of 225 degrees with pain in all planes of movement.  The 9 July 2007 general C&P examination showed a normal gait. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5237 (lumbosacral strain), citing “rated for spasm.”  The VA also rated the back condition 10%, analogously coded 5299-5014 (osteomalacia), based on the C&P examination, citing “painful or limited motion of a major joint or group of minor joints.”  

The panel considered the probative value of the conflicting ROM evidence presented in the applicable examinations and agreed the MEB ROM measurements were incomplete and incongruent with the NARSUM and C&P examinations, which were more complete, closer to separation, and held more probative rating value.  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/or combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the  NARSUM and VA examinations proximate to separation.  Although there was muscle spasm noted on the NARSUM examination, it was not severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  Additionally, although the CI cited a period of incapacitation within 1 year of separation, the STR did not provide such evidence that would support VASRD criteria for the same and thus no additional rating can be applied for intervertebral disc syndrome.  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 low back condition.  

Contended PEB Conditions:  Chronic Mild Cough and Chronic Right Knee Pain.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  Neither 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 either of the conditions significantly interfered with satisfactory duty performance at or near separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB’s fitness determination for either of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the low back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended cough and right knee 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 20170509, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180012283, 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