RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX		CASE: PD-2017-05277 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20090627

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E4, 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 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 - 20090522	VARD - 20091204	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5239	20%	Degenerative Changes of the Lumbosacral Spine	5242	10%	20090923	
Hyperlipidemia	Not Unfitting	No VA Placement	
Left Shoulder Tendonitis	Not Unfitting	Tendonitis of the Left Shoulder	5201-5010	10%	20090923	
Bilateral Upper Extremity Parathesias	Not Unfitting	Brachial Plexopathy, Left Upper Extremity	8515	0%	20090923	
		Brachial Plexopathy, Right Upper Extremity	8515	0%	20090923	
Right Knee Pain	Not Unfitting	Torn Right Meniscus	5262	0%	20090923	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 40%	
	
ANALYSIS SUMMARY:

Low Back Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition began in September 2007 after performing a fireman’s carry. Radiographic studies showed spondylolisthesis at L5-S1, but electrodiagnostic studies were normal. During the 20 January 2009 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported back pain with radicular symptoms and that it “hurts to sit to[o] long.” Physical examination showed decreased ROM (range of motion), but the examiner did not provide measurements. The next-day MEB NARSUM examination noted complaints of intermittent 6-7/10 back pain radiating to the foot aggravated by prolonged standing, walking or sitting. Physical examination showed a normal gait without evidence of abnormal spinal contour, spasm  or guarding,  but  there  was  tenderness.   Goniometric   ROM

testing showed flexion of 45 degrees (normal 90) and combined ROM of 105 degrees (normal 240), limited by pain in all planes of motion. Motor strength was normal, and straight leg raise testing was negative.

At the 23 September 2009 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported progressively worsening back pain, tingling legs, and “feet felt like stepping on needles.” Precipitating factors were running, jogging, prolonged walking and standing, going down stairs, overhead work, lifting, and carrying loads. The CI reported two episodes of incapacitation in the past 12 months, each lasting a day. Physical examination showed a normal gait and no evidence of abnormal spinal contour, tenderness or guarding, but there were muscle spasms. Thoracolumbar ROM testing, after repetition, showed flexion of 70 degrees and combined ROM of 185 degrees, limited by pain. Motor strength, reflexes and sensation were intact in the lower extremities.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the back condition 20%, coded 5239 (spondylolisthesis or segmental instability), citing 45 degrees of forward flexion. The VA rated the back condition 10%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing “forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees.” Panel members 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 the NARSUM examination. The panel considered whether a higher rating (§4.7) was achieved by using the alternate rating formula based on incapacitating episodes due to intervertebral disc syndrome (IVDS). Although the CI had IVDS and reported having two incapacitating episodes, the STR contained no objective evidence of incapacitating episodes requiring physician-prescribed bed rest of at least 4 weeks to warrant a higher rating under that alternate VASRD 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.

Contended PEB Conditions: Hyperlipidemia, Left Shoulder Tendonitis, Bilateral Upper Extremity Parathesias and Right Knee Pain. The panel first clarifies that hyperlipidemia is an abnormal laboratory finding and not a ratable physical disability. The panel’s main charge is to assess the fairness of the PEB determination that the other contended conditions were not unfitting. Although the left shoulder and upper extremity conditions were profiled, the NARSUM examiner noted there was no active treatment for either condition. None of the conditions were implicated in the commander’s statement or failed retention standards. There was no performance-based evidence from the record that any of the contended 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 left shoulder tendonitis, upper extremity paresthesias and left knee condition, the panel recommends no change from the PEB determination as not unfitting. In the matter of the contended hyperlipidemia, 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. Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.

PD-2017-05277
ARXXXXXXXXXXX, XXXXXXXXXXXXXXXXXXXXXXXX

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

PD-2017-05277