RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXX	CASE: PD-2017-04357
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20071210

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Helicopter Repair, medically separated for “lumbar degenerative disc disease (DDD)” with a disability rating of 10%.

CI CONTENTION:  CI requested review of 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 - 20071210	VARD - 20080312	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar DDD	5299-5242	10%	Lumbosacral DDD	5243	10%	20071126	

Multiple Joint Pain	

Not Unfitting	Right Shoulder Strain	5299-5201	0%	20071126	
		Left Shoulder Strain	5299-5201	0%	20071126	
		Left Wrist Strain	5215	0%	20071126	
		Right Wrist Strain	5215	0%	20071126	
		Left Knee Patellofemoral Pain Syndrome	5299-5260	0%	20071126	
		Right Knee PFPS	5299-5260	0%	20071126	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 60%	

ANALYSIS SUMMARY:

Lumbar DDD. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s lumbar DDD began in 2001 when the CI twisted while diving into the pool during physical therapy (PT) and felt a pop in his lower back. The CI incurred a second injury in February 2005 when he and another soldier were in a military van storing a six-seat “golf cart” when the support

collapsed and they had to hold the cart for approximately 4 minutes until other personnel could arrive to relieve them. The 27 July 2007 PT examination, 4 months prior to separation, showed flexion at 25 degrees (normal 90) with combined range of motion (ROM) at 160 degrees (normal 240). Abnormal limitation of motion was due to pain. There was no muscle spasm or guarding and gait was normal. Tenderness was localized. No abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis was observed.

During the 16 August 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, physical examination showed a normal gait. There was paraspinal tenderness and limitation of movement (decreased flexion, extension, lateral flexion and rotation). Pain was elicited by extension, rotation, flexion and bilateral straight leg raise (SLR). Straight leg raise testing to elicit radicular symptoms was negative. Gait was normal. Bilateral motor strength was 5/5, reflexes were normal, sensation was intact to touch.

The 2 October 2007 MEB NARSUM examination, 2 months prior to separation, noted complaints of chronic lower back pain with no benefit from nonnarcotic medication and fear of narcotic medication due to dependency concerns. The pain was described as constant and moderate. Physical examination referred to the PT note dated July 2007 for ROM measurements. Bilateral paraspinous muscle tenderness was noted. SLR testing to elicit radicular symptoms was negative. Gait was normal.  Lower extremity strength and sensation were normal.

At the 26 November 2007 VA Compensation and Pension (C&P) examination, one month before separation, the CI reported not being able to lift greater than 50 pounds and difficulty with bending activities. Physical examination showed tenderness to the lower back and SLR caused pain in the lower back. Flexion of the lumbar spine was 90 degrees with pain and combined ROM was 240 degrees with pain.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the lumbar DDD 10%, analogously coded 5299-5242 (degenerative arthritis of the spine), citing no evidence of motor neurologic deficit. Examination showed localized tenderness with ROM limited by pain. The VA also rated the lumbosacral DDD condition 10%, coded 5243 (intervertebral disc syndrome [IVDS]) based on the C&P examination, citing muscle spasm, guarding or localized tenderness not resulting in abnormal gait or spinal contour. The panel agreed a 10% rating was justified for the presence of painful motion and tenderness. 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 lumbar DDD condition.

Contended PEB Condition: Multiple Joint 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. At the MEB examination (recorded on the DD Form 2808 and 2807-1), the CI reported pain and stiffness of his joints including shoulders, elbows, and wrists and was referred for further evaluation with primary care. At a primary care visit on 6 September 2007, 3 months prior to separation, in addition to his back, the CI reported joint pain in the hands, shoulders and knees. Physical examination of the wrists, hands and fingers was normal bilaterally. The 2 October 2007 MEB NARSUM noted the CI was being evaluated by his primary care provider for multiple joint pain and testing for rheumatoid arthritis was negative and HLA testing was negative (associated with many conditions which include joint pain). There was no performance-based evidence from the record that the multiple joint pain 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 lumbar degenerative disc disease and IAW VASRD §4.71, the panel recommends no change in the PEB adjudication. In the matter of the contended multiple joint condition, the panel agrees it cannot recommend it for additional disability rating. 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-2017-04357

AR20190012717, 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.

PD-2017-04357