RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2017-05248
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080417

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E6, Infantryman, medically separated for “low back pain” with a disability rating of 20%.

CI CONTENTION:  Review all conditions.  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 - 20080229	VARD - 20081117	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5299-5237	20%	Lumbar Degenerative Disc Disease	5243	20%	20080617	
Bilateral Knee Pain	Not Unfitting	Degenerative Joint Disease, Left Knee	5003-5260	10%	20080617	
		Degenerative Joint Disease, Right Knee	5003-5260	10%	20080617	
Bilateral Elbow Pain	Not Unfitting	Olecranon Spurs, Left Elbow	5099-5015	0%	20080617	
		Olecranon Spurs, Right Elbow	5099-5015	0%	20080617	
GERD	Not Unfitting	Gastroesophageal Reflux Disease (GERD)	7399-7346	NSC	20080617	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in November 2006 after twisting his back during MOPP training.  Radiographic studies showed mild disc bulges at L3-4 and L4-5 without any significant canal stenosis or neural foraminal narrowing, but electrodiagnostic testing in October 2007 documented mild peripheral neuropathy affecting the right tibial motor and left sural nerves.

The 30 October 2007 MEB NARSUM examination, 6 months prior to separation, noted complaints of low back pain and numbness at the left thigh, calf and toes with prolonged sitting.  Physical examination showed a normal gait and normal heel-to-toe gait.  There was no muscle spasm.  Thoracolumbar range of motion (ROM) measurements showed flexion of 40 degrees (normal 90) and combined ROM of 165 degrees (normal 240), after repetition.  Motor, reflex, sensory and pulse examinations were all normal.

At the 17 June 2008 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported constant low back pain aggravated by bending and prolonged sitting.  Prolonged sitting also caused tingling in both legs that resolved after changing positions or moving around.  Physical examination showed a normal gait and no spasm.  After repetitive testing, thoracolumbar flexion was 55 degrees and combined ROM was 190 degrees with pain.  There was no lower extremity motor, reflex, of sensory deficits.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 20%, analogously coded 5299-5237 (lumbar spine strain), citing limitation of flexion.  The VA also rated the back condition 20%, coded 5243 (intervertebral disc syndrome (IVDS)), based on the C&P examination, citing limitation of flexion.  The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees), as reported on all examinations.  There was no documentation of IVDS with incapacitating episodes which would provide for a higher rating under that formula.  

The panel next considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  Although the CI reported radiating back pain into his lower extremities, this pain is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  There was no objective evidence of a radiculopathy with functional impairment (such as weakness) that directly impacted fitness for duty.  The panel therefore concluded that an additional disability rating was not justified on this basis.  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.  

Contended PEB Conditions:  Bilateral Knee Pain, Bilateral Elbow Pain and GERD.  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, implicated in the commander’s statement or judged to 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 back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended radiculopathy, bilateral knee pain, bilateral elbow pain and GERD 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.

XXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXX

	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.