[AR Number], XXXXXXXXXX. 

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX:

	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.

Enclosure

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX.	CASE:  PD-2017-04817
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20091017

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty O3, Quarter Master General, medically separated for “chronic intervertebral disc syndrome [IVDS]” and “chronic right ankle,” rated 10% each, with a combined disability rating of 20%.

CI CONTENTION:  Review requested of back and additional conditions 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 - 20090514	VARD - 20101015	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic IVDS	5243	10%	Lumbar DDD with Osteoarthritis	5242-5243	10%	20100222	
Chronic Right Ankle	5099-5003	10%	Right Ankle Surgical Scar…	5271	0%		
			Right Ankle Nerve Injury	8521	NSC		
Lactation Disorder	Not Unfitting	No VA Placement	
Bilateral Gastrocnemius Soleus Equinus		No VA Placement	
Plantar Fasciitis		Bilateral Plantar Fasciitis/ Fibromatosis	5299-5284	NSC		
Chronic Pelvic Pain		Recurrent Ovarian Cyst	7628	NSC		
Endometriosis		Status Post Transvaginal Hysterectomy…	7629-7618	30%		
Symptomatic Pelvic Engorgement						
Mild Facet Hypertrophy		Cervical and Thoracic Spine Segmental Dysfunction	5237	NSC		
Migraine Headaches		Chronic Migraine Headaches	8100	30%		
Right Wrist Arthropathy		Right Wrist Strain…	5215-5024	0%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:

Chronic IVDS.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI first experienced low back pain (LBP) in the fall of 2004 without a specific injury.  She was treated with both physical therapy (PT) and chiropractic manipulation without resolution.  An MRI on 8 December 2005 showed degenerative disc disease (DDD) with a tear at L4-5 and protrusion at L4-5 and L5-S1. 

On 15 October 2008, an MRI revealed only DDD at L5-S1, but also showed arthritic changes at L4-5 and L5-S1.  In orthopedics on 13 November 2008, the CI was noted to be obese and weight loss of at least 50 pounds was recommended.  Spine X-rays that day were unremarkable other than the DDD, and neurological findings were intact (no radicular symptoms).  Despite treatment, the pain persisted. A discogram on 24 December 2008 showed concordant pain at the L5-S1 disc.  

During the 13 January 2009 MEB NARSUM, 9 months prior to separation, the CI reported longstanding LBP, which began during field exercises.  Physical examination noted tenderness and an intact motor examination.  The 24 March 2009 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months before separation, noted complaints of chronic back pain.  Physical examination revealed normal strength and one sign of non-organic pain.  The CI declined to bend forward or squat due to LBP.  The next day, MEB ROM measurements in PT showed flexion to 85 degrees (normal 90) and a combined ROM of 235 degrees (normal 240).  Flexion was noted to be limited by soft tissue, and tenderness, spasm, and guarding were absent.  

At the 22 February 2010 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported ongoing LBP which limited walking to half a mile, but she denied incapacitation.  Physical examination showed a normal gait and posture, lumbar tenderness, and no spasm.  ROM was painful, but full.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic IVDS 10%, coded 5243 (IVDS), citing painful motion.  The VA rated lumbar DDD 10%, coded 5242-5243 (degenerative arthritis of the spine–IVDS), based on the C&P examination, citing localized tenderness.  Members agreed that the painful motion and tenderness documented on both the MEB and VA examinations supported a 10% rating, but no higher.  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 IVDS.  

Chronic Right Ankle.  According to the STR and MEB NARSUM, the CI twisted her right ankle in 2005 during a field exercise.  In July 2007, X-rays were normal, but in June 2008, an MRI showed that the anterior talofibular ligament was “largely absent” and that the other lateral ligaments were intact.  The CI reported pain and instability, and during a PT visit for strengthening prior to surgery, the provider noted an “unremarkable” gait, full ROM without effusion, and no instability.  She was seen in the foot and ankle clinic on 11 February 2009 for a second opinion and ROM evaluation showed dorsiflexion of 5 degrees (normal 20) and plantar flexion of 25 degrees (normal 45).   She was placed in a brace for soft tissue rest.  At an orthopedic examination on 24 February 2009, the CI reported subjective instability and the provider noted painful motion and a stable ankle.  

The 26 February 2009 MEB NARSUM orthopedic addendum examination, 8 months prior to separation, noted CI complaints of right ankle pain since 2005.  The physical examination showed normal skin coloration without swelling, tenderness along the lateral ankle, and painful motion.  The ankle was stable, but there was weakness compared to the left; stress X-rays (for laxity) were normal.  At a follow-up foot and ankle appointment on 16 March 2009, the examination was essentially unchanged.  A CT scan that day showed degenerative changes of the ankle bones.  

During the 24 March 2009 MEB examination, (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, the CI reported that she had sprained her right ankle, and the examiner noted that she could not toe walk due to ankle pain.  During the 25 March 2009 MEB ROM PT study, the examiner noted a normal gait.  Right ankle dorsiflexion was to 10 degrees and plantar flexion to 45 degrees.  The unaffected left side showed dorsiflexion to 15 degrees and plantar flexion to 45 degrees.  The CI was thought to have a limitation in dorsiflexion due to tightness of the gastrocnemius muscles bilaterally and stretching was recommended.  At a PT visit on 31 August 2009, the therapist noted a right ankle surgery on 7 July 2009 (not in evidence).  Dorsiflexion was to 5 degrees and plantar flexion to 20 degrees, and she favored the right ankle when walking.  

At the 22 February 2010 C&P examination, 4 months after separation, the CI reported ongoing right ankle pain since falling into a hole on a training exercise, but denied incapacitation.  Physical examination was unremarkable and showed normal gait and posture, and full, pain-free ROM. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the “chronic right ankle” condition 10%, analogously coded 5099-5003 (degenerative arthritis), for painful motion.  The VA rated the right ankle condition 0%, coded 5010-5271 (arthritis due to trauma-limited motion of the ankle), based on the C&P examination, citing no objective evidence of limited or painful motion.  The VA also determined that a right ankle nerve injury, coded 8521 (paralysis of the common peroneal nerve), was not service connected, citing a normal examination.  Panel members noted that limited and painful motion was present prior to separation, but had resolved shortly afterwards.  While the evidence suggested that a non-compensable rating was more appropriate, the panel may not recommend a combined rating lower than that adjudicated by the PEB.  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 chronic right ankle condition.  

Contended PEB Conditions:  Lactation Disorder, Bilateral Gastrocnemius Soleus Equinus, Plantar Fasciitis, Chronic Pelvic Pain, Endometriosis, Symptomatic Pelvic Engorgement, Mild Facet Hypertrophy, Migraine Headaches, and Right Wrist Arthropathy.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement, and did not fail retention standards.  There was no performance-based evidence from the record that any 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 any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the chronic intervertebral disc syndrome and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the chronic right ankle condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended lactation disorder, bilateral gastrocnemius soleus equinus, plantar fasciitis, chronic pelvic pain, endometriosis, symptomatic pelvic engorgement, mild facet hypertrophy, migraine headaches, and right wrist arthropathy 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: