RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04867
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060809

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E4, Human Resource Specialist, medically separated for “chronic myofascial back pain” with a disability rating of 10%.   

CI CONTENTION:  “The multiple documents that I have provided in support of this claim, all have found that I was unfit from multiple sources.” 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 - 20060712	VARD - 20070730	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Myofascial Back Pain	5299-5237	10%	Thoracic and Lumbar Muscle Spasm	5237	10%	20060922	
Patellofemoral Syndrome	Not Unfitting	Left Knee Patellofemoral Syndrome	5020	10%	20060922	
		Right Knee Patellofemoral Syndrome	5024	10%	20060922	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Myofascial Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in April 2005 after lifting heavy equipment.  Radiographic studies were negative as was blood work for inflammatory or connective tissue disease.  The CI was felt to have chronic myofascial thoracolumbar pain due to a traumatic strain/stress to his back tissue and muscles.  The 10 April 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, revealed tenderness and spasm.  Range of motion (ROM) testing showed flexion of 80 degrees (normal 90) and combined ROM of 220 degrees (normal 240).  The remainder of the examination was noted as “unremarkable.” During the 23 May 2006 MEB NARSUM examination, 3 months prior to separation, the CI complained of pain in the mid thoracic and left side of the back and into the upper left shoulder, with feelings of spasm and tightness in the back.  Physical examination showed thoracolumbar flexion of 80 degrees and combined ROM of 220 degrees with painful motion.

At the 22 September 2006 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported pain occurring five times per day and each time lasting for one hour.  The pain was localized, burning, sharp and cramping in nature.  Pain intensity was rated 10/10.  Pain was elicited by physical activity and sudden movement.  Physical examination showed a normal gait without radiation of pain on movement, but there was spasm and tenderness.  The straight leg raise test was negative and no ankylosis of the lumbar spine was noted.  Thoracolumbar ROM testing showed flexion of 45 degrees and combined ROM of 195 degrees with painful motion.  The examiner indicated joint function of the spine was additionally limited by 60 degrees due to pain after repetition, but provided no specifics.   Joint function was not additionally limited by fatigue, weakness, stiffness, inflammation, lack of endurance or incoordination.  Thoracic and lumbar spine X-rays were normal.  At a VA primary care visit on 8 January 2007, 5 months after separation, physical examination showed full ROM of the back without tenderness.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5299-5237 (lumbosacral strain), citing thoracolumbar ROM limited by pain with localized tenderness.  The VA also rated the back condition 10%, coded 5237, based on the C&P examination, citing muscle spasm, guarding or localized tenderness not resulting in abnormal gait or abnormal spinal contour.   The panel agreed that a 20% rating was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees) as reported on the VA examination, which was most proximal to separation.  The VA examiner indicated there was an additional 60 degrees loss of ROM with repetition, but did not indicate whether the flexion ROM was reduced to 30 degrees or less after repetition.  An overall decrease of the combined ROM of 60 degrees from 195 degrees to 135 degrees only supports a 10% rating.  The panel considered a primary care visit 5 months after separation that noted full ROM of the back and concluded a 20% rating, but no higher, was supported for the back condition at separation based on the VA flexion measurement and consideration of functional loss.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the back condition, coded 5299-5237  

Contended PEB Condition.  Patellofemoral Syndrome.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The condition was profiled and implicated in the commander’s statement, but was not judged to fail retention standards.  The MEB NARSUM indicated the CI was given an L2 profile for the condition and an L3 profile for the back condition.  An L2 profile designation indicates a condition which requires some physical limitations, but is not disqualifying for continued military service in all cases.  The MEB NARSUM examiner determined the condition was medically acceptable.  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, so no additional disability rating is recommended. 

BOARD FINDINGS:  In the matter of the back condition, the panel recommends a disability rating of 20%, coded 5299-5237 IAW VASRD §4.71.  In the matter of the contended patellofemoral syndrome, 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.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Myofascial Back Pain	5299-5237	20%	

XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified to 20% but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,					       
						      					
Enclosure