RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-05041
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070606

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Multiple Launch Rocket System Crewmember, medically separated for “pulmonary embolism” and “chronic back pain status post lumbar fusion,” rated 10% and 0%, respectively, with a combined disability rating of 10%.  

CI CONTENTION:  “My conditions with my back, feet, knees and hypertension affected my ability to work in the civilian world.  ”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 - 20070330	VARD - 20070613	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Pulmonary Embolism	7199-7120	10%	Pulmonary Embolism	6843	0%	20070302	
Chronic Back Pain… 	5299-5241	0%	Intervertebral Disc Syndrome, Thoracolumbar Spine	5243	Deferred	20070302	
Hypertension	Not Unfitting	Hypertension	7101	0%	20070302	
Genu Valgum Deformity	Not Unfitting	Retropatellar Pain Syndrome, Right Knee	5299-5257	10%	20070302	
		Retropatellar Pain Syndrome, Left Knee	5299-5257	10%	20070302	
Pes Planus	Not Unfitting	Pes Planus with Right Foot Fifth Metatarsal Fracture	5276	10%	20070302	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60% 	

ANALYSIS SUMMARY:  

Pulmonary Embolism.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s respiratory condition began in July 2006 with development of a deep vein thrombosis and pulmonary embolism.  He was treated with anticoagulation medication until February 2007.  The 9 January 2007 MEB NARSUM pulmonary and cardiovascular examinations, 5 months prior to separation, were normal.  

At the 2 March 2007 VA Compensation and Pension (C&P) examination, 3 months before separation, the CI reported limitation of physical activity and difficulty breathing.  Physical examination of the heart and lungs was normal, and pulmonary function testing demonstrated FEV1 at 107% predicted and FEV1/FVC of 85.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the respiratory condition 10%, analogously coded 7199-7120 (varicose veins), citing “on chronic anticoagulation.”  The VA rated the respiratory condition 0%, analogously coded 6843 (traumatic chest wall defect), based on the C&P examination, citing pulmonary function test results.  Members noted that while PEB cited continued anticoagulation for a 10% rating, the CI had actually been removed from anticoagulation therapy 4 months before separation.  There was no evidence of residual cardiovascular or pulmonary symptoms prior to separation, and the panel agreed that the evidence supports a 0% rating under 6817 (pulmonary vascular disease) because the CI was asymptomatic after resolution of the pulmonary embolism. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 0% for the pulmonary embolism condition, coded 6817.  

Chronic Back Pain.  According to the STR and MEB NARSUM, the CI underwent back surgery with spinal fusion in April 2006 for degenerative disc disease.  The 28 December 2006 physical therapy (PT) range of motion (ROM) measurements, in degrees, revealed: flexion to 65 (normal 90), extension to 20 (normal 30), right and left lateral flexion to 30 (normal), right rotation to 40 (normal 30), and left rotation to 30 (normal); combined ROM was 205 (normal 240).  The 9 January 2007 MEB NARSUM examination referenced the above mentioned PT measurements.  

A the 16 March 2007 PT ROM study, 3 months before separation, measurements, in degrees, showed: flexion to 80, extension to 30, right and left lateral flexion to 40, right rotation to 45, and left rotation to 50; combined ROM was 230.  Physical examination noted pain limited motion but no tenderness or muscle spasms, and a normal gait.  The 27 March 2007 MEB NARSUM addendum examination referenced the aforementioned PT evaluation.  

During the 24 October 2007 VA Compensation and Pension (C&P) spine addendum examination, 4 months after separation, the CI reported lower back stiffness, weakness, and sharp pain.  Physical examination showed a normal gait and no back tenderness or muscle spasms.  Measured ROM, in degrees, was:  flexion to 45, extension to 10, left and right lateral flexion to 20, and left and right rotation to 20; combined range of motion was 135; motion was limited by pain. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 0%, analogously coded 5299-5241 (spinal fusion), citing ROM limited by pain and without spasms or tenderness.  The VA rated the low back condition 20%, coded 5243 (intervertebral disc syndrome), based on the C&P examination, citing forward flexion to 45 degrees.  Although the C&P examination recorded limited flexion which met criteria for a 20% rating, the panel placed higher probative value on the PT measurements performed prior to separation in evaluating the CI’s functional limitations.  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 combined ROM (greater than 120 degrees but not greater than 235 degrees).  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.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the low back condition, coded 5299-5241.  

Contended PEB Conditions:  Hypertension, Genu Valgum Deformity and Pes Planus.  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:  Although the panel recommends a 0% rating for the pulmonary embolism and a 10% rating for the chronic back pain, the combined 10% rating does not result in any benefit to the CI; therefore, in the matter of the pulmonary embolism and IAW VASRD §4.97, the panel recommends no change in the PEB adjudication.  In the matter of the chronic low back pain and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended hypertension, genu valgum deformity and pes planus 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.  

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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.

Sincerely,					      
Enclosure