RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX		CASE: PD-2017-03794 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20051129

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E6, Infantryman, medically separated for “chronic low back pain” and “chronic right shoulder pain,” rated 10% each, with a combined disability rating of 20%.

CI CONTENTION: “Still having trouble with back, neck, and shoulder. Hearing, hip, both wrists still same, 2 surgeries on shoulder.”  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 - 20050511	VARD - 20061204	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5242	10%	Lumbosacral Strain	5237	20%	20060202	
Chronic Right Shoulder Pain	5099-5003	10%	Rotator Cuff Strain, Right	5299-5201	20%	20060202	
Neck Pain	Not Unfitting	DDD, Cervical Spine	5243	20%	20060202	
Numbness of Both Wrists	Not Unfitting	Carpal Tunnel Syndrome, Right	8515	10%	20060202	
		Carpal Tunnel Syndrome, Left	8515	10%	20060202	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 70%	
	
ANALYSIS SUMMARY:

Chronic Low Back Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition began insidiously in February 2005. Radiographic imaging studies revealed an L4-5 disc herniation with mild stenosis of the corresponding nerve.

At the 30 September 2005 MEB NARSUM examination, 2 months prior to separation, the CI complained of low back pain. His physical examination (PE) revealed tenderness about the lower spine without associated muscle spasms, abnormal gait or abnormal spinal contour. Range of motion (ROM) of the back showed forward flexion of 70 degrees (normal 90) and combined ROM of 210 degrees (normal 240) with pain.

During the 2 February 2006 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported constant lumbar pain, which flared with extended standing. He denied bowel or bladder incontinence, lower extremity weakness, episodes of incapacitation or radiation of pain into the lower extremities; however, he did report numbness in the both heels. He also reported being fully employed and that his back condition caused no employment restrictions. The PE noted a normal gait and spinal curvature without muscle spasm. Spinal tenderness was present. Spinal ROM testing was painful and showed forward flexion of 65 degrees and combined ROM of 190 degrees.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the back condition 10%, analogously coded 5299-5242 (degenerative arthritis of the spine), citing ROM limited by pain and positive tenderness. The VA rated the back condition 20% coded 5243 (intervertebral disc syndrome [IVDS]), based on the C&P examination, citing forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees.

Panel members agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) or alternatively for combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the examinations proximate to separation. 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 evidence of IVDS which resulted in incapacitating episodes requiring physician- prescribed bed rest to warrant consideration of rating under the alternate VASRD formula for that condition. 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 Shoulder Pain. According to the STR and MEB NARSUM, the right-handed CI’s right shoulder condition began in February 2005 after heavy lifting. Radiographic imaging revealed degenerative changes in the front portion of the shoulder. The MEB NARSUM examination, 2 months prior to separation, noted complaints of right shoulder pain “worse with overhead arm work.” The PE revealed tenderness about the right shoulder. Right shoulder ROM was painful and measured flexion to 130 degrees (normal 180) and abduction to 120 degrees (normal 180).

At the VA C&P examination, 2 months after separation, the CI reported constant right shoulder pain that radiated into the right hand. Painful flare-up aggravators included heavy lifting or rotating the arm. The CI denied job-related interference due to this condition. Right shoulder ROM testing revealed normal flexion, but abduction was painful and limited to 100 degrees. Repetitive motion testing did not produce any additional pain, change in ROM, fatigability, weakness, or incoordination.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right shoulder condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing slight and constant pain IAW the U.S. Army Physical Disability Agency pain policy. The VA rated the right shoulder condition 20%, analogously coded 5299-5201 (arm, limitation of motion), citing limitation of motion approximating shoulder level.

The VASRD §4.71a threshold for rating for ROM impairment (code 5201, arm limitation of motion) is “at shoulder level” (approximately 90 degrees from the side), and the examinations in

evidence demonstrated motion above this level. Although there was insufficient limitation of motion to support a rating under the 5201 code, panel members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion). There was no malunion or recurrent dislocation of the humerus to justify a rating under the 5202 code (humerus, other impairment); and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating under the 5203 code (clavicle or scapula, impairment). After due deliberation, considering all the evidence and mindful of VASRD §4.3, the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the right shoulder condition.

Contended PEB Conditions: Neck Pain and Numbness of Both Wrists. The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting. Although both conditions were implicated in the commander’s statement, the author of that instrument admitted that he had not seen the duty performance of the CI and his comments were based on superseded temporary profiles. Also, neither of the conditions were permanently profiled nor failed retention standards. There was no performance-based evidence from the record that either 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 either 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 contended neck pain and bilateral hand numbness, 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:

PD-2017-03794 

AR20190011829, XXXXXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXXX

	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.

PD-2017-03794