RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04423
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20080320

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Indirect Fire Infantryman, medically separated for “lumbar degenerative disc disease” with a disability rating of 10%.   

CI CONTENTION:  The CI contended for his back condition as well as lower extremity radiculopathy and bilateral knees.  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 - 20080417	VARD - 20080826	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar Degenerative Disc Disease	5299-5242	10%	Degenerative Disc Disease of the Lumbar Spine 	5242	10%	20080731	
Bilateral Knee Pain	Not Unfitting	Bilateral Knee Condition	5099-5019	NSC	20080731	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:  

Lumbar Degenerative Disc Disease.   According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in April 2007 after he strained his back while working on a car.  He was treated conservatively throughout the course of his injury with medication, profiling, chiropractic treatment and physical therapy.  An MRI on 1 July 2007 showed a small central disc extrusion at L5-S1 and a small left posterolateral annular disc bulge and annular tear at L4-5.  
At the 28 August 2007 orthopedic clinic examination, 7 months prior to separation, the CI complained of right-sided lower back pain and right sciatica.  His pain radiated to his right buttock and was exacerbated by sitting or driving.  There was no weakness or numbness in the lower extremities, but there was tingling in the posterior right thigh.  During the October 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, range of motion (ROM) of the back was limited due to pain, with no spasm or mass present.  Straight leg raise testing was positive. 

The 7 December 2007 MEB NARSUM examination, 3 months prior to separation, noted complaints of constant 6/10 back pain aggravated by walking.  The CI could not run, wear Kevlar, IBA or march due to pain.  He denied weakness, numbness or tingling.  The pain was sharp in nature and localized to his mid back.  Physical examination showed tenderness to palpation over the para lumbar muscles with a completely normal neurologic examination.  ROM measurements conducted by physical therapy (PT) on 5 November 2007 using an inclinometer (except for rotation measurements, which were taken with a goniometer) showed flexion of 65 degrees (normal 90) and combined ROM of 200 degrees (normal 240).  

At the 31 July 2008 VA Compensation and Pension (C&P) general medical evaluation, 4 months after separation, the CI reported constant low back pain with radicular pain into his right leg to his knee that occurred one to three times per day.  His symptoms were aggravated by sitting over 15 minutes, walking over 20 minutes, standing over 25 minutes, bending and lifting.  The CI denied incapacitating episodes or urinary incontinence.  Physical examination showed a normal gait and stance with no spinal ankyloses.  ROM measurements were flexion of 90 degrees and combined ROM of 240 degrees.  Muscle strength was normal and there was no guarding, spasm, tenderness, swelling or effusion noted.  Straight leg raise testing was negative and all other neurologic examination findings were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded analogously 5299-5242 (degenerative arthritis of the spine), citing tenderness and range of motion limited by pain.  The VA also rated the low back condition 10%, coded 5242.  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 PT examination 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 documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula.  After due deliberation, considering all of 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 Condition:  Bilateral Knee Pain.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement nor judged to fail retention standards.  There was no performance-based evidence from the record that the 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 and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the back condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended bilateral knee pain, the panel unanimously recommends no change from the PEB determination 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 20170405, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180006643, 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