RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-04926 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20040312

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, UH-60 Helicopter Repairman, medically separated for “chronic back pain,” “heart palpitations” and “chronic pain, right ankle,” rated 10%, 10% and 0%, respectively, with a combined disability rating of 20%.

CI CONTENTION: In addition to the unfitting conditions, the CI requested several other 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 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 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 - 20040202	VARD - 20040520	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5241	10%	Spondylolisthesis, Lumbar Spine	5239	10%	STR	
Heart Palpitations	7099-7010	10%	Ventricular Tachycardia	7011	0%	STR	
Chronic Pain, Right Ankle	5099-5003	0%	Degenerative Changes, Right Ankle	5010-5271	10%	STR	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 20%	
	
ANALYSIS SUMMARY:

Chronic Back Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition began insidiously in 1997 without injury or trauma. Radiographic studies showed spondylolisthesis and spondylolysis at L5. He underwent spinal fusion at L5-S1 in February 2002. The 13 November 2003 MEB NARSUM examination, 4 months prior to separation, noted complaints of chronic low back pain. Physical examination showed “limited and painful range of motion (ROM).” At the 21 January 2004 physical therapy (PT) MEB ROM study, 2 months prior to separation, the examiner documented 68 degrees of flexion (normal 90) and 200 degrees of combined ROM (normal 240). Measurementes were taken with an inclinometer. The 22 January 2004 addendum to the MEB showed no lower extremity weakness or atrophy, and sensory function was intact. There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the back condition 10%, coded 5241 (spinal fusion), citing combined ROM of 218 degrees. The VA also rated the back condition 10%, coded 5239 (spondylolisthesis or segmental instability), based on the STR, citing flexion of 68 degrees. Although the physical therapist used an inclinometer instead of the VASRD-compliant goniometer to measure ROM for the MEB, there were no other ROM studies from which to base a rating. 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) or alternatively for 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 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.

Heart Palpitations. According to the STR and MEB NARSUM, the CI underwent cardiac evaluation in 2000 with echocardiogram for heart palpitations. The echocardiogram “showed borderline concentric left ventricular hypertrophy, but no focal wall motion abnormality. Holter and event monitor studies in May 2000 were normal. A repeat echocardiogram in April 2001 showed normal left ventricular size and contractility. There was flail chordae tendinae, but no mitral valve prolapse. A Holter monitor in April 2001 showed one brief three-beat run of nonsustained ventricular tachycardia that corresponded with symptoms, but the study was otherwise normal. Adenosine/thallium stress testing in June 2001 was negative for ischemia. The MEB NARSUM examination noted complaints of difficulty increasing exercise tolerance due to palpatations, and inability to engage in persistent, physically stressful activities. The CI was taking medication for hypertension, but not for palpatations.  Physical examination noted normal chest X-rays.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the heart condition 10%, analogously coded 7099-7010 (supraventricular arrhythmias), citing “one documented abnormal tracing in the past year.” The VA rated the heart condition 0%, coded 7011 (sustained ventricular arrhythmias), based on the STR, citing “normal stress test, normal echocardiogram, and no medication required for treatment.” Panel members agreed, the 10% rating, and no higher, was justified under code 7010 for one to four episodes per year of non-sustained supraventricular tachycardia documented by EKG or holter monitor. There was one episode documented by Holter monitor in April 2001. Although, the CI reported other episodes of heart palpatations, there was no EKG or Holter monitor evidence of additional events. There were no additional codes that would provide for a higher rating. 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 heart condition.

Right Ankle Chronic Pain. According to the STR and MEB NARSUM, the CI underwent right ankle reconstruction in July 2001. At the March 2002 orthopedic examination, 24 months prior to separation, the CI reported an asymptomatic right ankle and that he was doing well. ROM testing for the right ankle showed 40 degrees of plantar flexion (normal 45) and 10 degrees of dorsiflexion (normal 20). During the MEB NARSUM examination the CI complained of residual right ankle pain that interfered with his ability to run. Running caused significant ankle pain. Physical examination was normal except for a surgical scar.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right ankle condition 0%, coded 5099-5003 (degenerative arthritis), citing minimal and intermittent pain IAW the US Army Physical Disability Agency pain policy.  The VA rated the

right ankle condition 10%, dual coded 5010-5271 (traumatic arthritis causing limitation of ankle motion), based on the STR, citing the condition is considered painful and warrants the minimum evaluation of 10%. Panel members agreed there was no limitation of dorsiflexion or plantar flexion that supported a rating under the VASRD diagnostic code for limitation of motion (5271). The CI had a normal ankle examination at the NARSUM, and evidence of painful motion with functional loss was not present in the STR. There was no evidence of ankle treatment or examinations in the 12 months before separation. Panel members concluded, there was insufficient evidence to support a rating based on limitation of motion with functional loss. The panel considered alternative VASRD ankle and analogous codes, but all were less applicable and/or not advantageous to rating.

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 heart condition and IAW VASRD §4.104, the panel recommends no change in the PEB adjudication. In the matter of the right ankle condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. 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.

DEPARTMENT OF THE ARMY
ARMY REVIEW BOARDS AGENCY
251 18TH STREET SOUTH, SUITE
385
ARLINGTON, VA 22202-3531

AR20190013953

Dear XXXXXXXXXXXXXXXX:
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

Printed on	Recycled Paper