RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05313
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070712

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Multichannel Transmission Systems Operator-Maintainer, medically separated for “chronic low back pain” with a disability rating of 10%.  

CI CONTENTION:  “Medical conditions were continually exacerbated by deployment conditions and training.”  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 to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the Medical Evaluation Board 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 - 20070521	VARD - 20080114	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5241	10%	Lumbar Disc Disease, Status Post L4-5 Fusion	5010-5241	10%	20071215	
Retropatellar Pain Syndrome	Not Unfitting	Left Knee Strain	5260	10%	20071215	
		Right Knee Strain	5260	10%	20071215	
Hypertension	Not Unfitting	Hypertension 	7101	0%	20071215	
Esophageal Reflux Disorder	Not Unfitting	GERD	7399-7346	0%	20071215	
Correctable Vision 	Not Unfitting	No VA Placement?	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30% 	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s LBP began insidiously and was first reported in February 2000 without a traumatic incident.  Imaging studies showed a mild focal disc protrusion with a large associated annular tear at L4-5 and annular degeneration at L3-4, L4-5, and L5-S1.  After undergoing epidural steroid injections without relief, he had a lumbar fusion of L4-5 (posterior and interbody arthrodesis of L4-5 with instrumentation and local autograft) on 5 October 2006.  At the 3-month postoperative orthopedic visit on 27 December 2006, the CI reported pain rated at 3/10 compared to 7-8/10 preoperatively.  He had approximately 20-30 degrees of lumbar flexion and 10 degrees of extension with symmetric lower extremity strength sensation grossly intact.  At the 14 March 2007 orthopedic appointment, 4 months prior to separation, the CI reported that he felt 60% better with regard to his back pain.  The examiner noted “good” range of motion (ROM) that was not limited by pain, and normal lower extremity normal strength, sensation, and reflexes.  Imaging showed healing and hardware (pedicle screws and the interbody device) in satisfactory positions. 

The 20 April 2007 MEB NARSUM examination, 3 months before separation, noted a complaint of LBP with typical pain rated at 4-5/10, but increased to 7-8/10 after activities.  Conservative treatment, physical therapy, multiple steroid injections and an L4-5 fusion did not resolve the pain.  Physical examination showed a moderate loss of back extension and flexion while standing, but not while lying or sitting.  However, the CI exhibited full bilateral side bending and rotation.  There was mild/moderate spinal tenderness at L4-5, but the spine appeared normal with no evidence of scoliosis.  Straight leg raising (to determine nerve root irritation) was negative.  Gait and strength were normal, and deep tendon reflexes were 2/4.  

At the 15 December 2007 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported LBP, and the examiner noted a normal gait and no spinal tenderness.  Range of motion (ROM), after repetition, revealed thoracolumbar flexion of 90 degrees (normal) with a combined ROM of 240 degrees (normal).  There was no pain with motion or loss of motion with repetition, and no motor or sensory loss.  Imaging demonstrated a fusion at L4-5 stabilized by posterior metallic hardware including transpedicular screws.  The vertebral bodies were aligned appropriately with no fracture or compression deformity, and intervertebral disc spaces appeared normal. 

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 moderate tenderness with no spasm or deformity, and motion limited by pain.  The VA also rated the back condition 10%, but dual coded 5010-5241 (arthritis due to trauma-spinal fusion), based on the C&P examination, citing functional loss due to pain.  Members agreed that a 10% rating, but no higher, was justified for moderate tenderness with no spasm or deformity, and motion limited by pain as well as functional loss due to pain as reported on the MEB NARSUM examination.  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 low back condition.  

Contended PEB Conditions:  Retropatellar Pain Syndrome, Hypertension, Esophageal Reflux Disorder and Correctable Vision.  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.  

The MEB NARSUM indicated the CI had a leg length discrepancy noted in April 2000, and a right heel lift was provided.  Knee pain in April 2001 resulted in the diagnosis of patellofemoral pain syndrome with occasional care for the knee pain thereafter.  The NARSUM examiner noted bilateral knee joint line tenderness medially and laterally without ligamentous laxity; otherwise the knees were normal.  A right knee MRI dated 27 April 2007 demonstrated small fluid-like densities suggesting inflammation along the anterior and posterior cruciate ligaments, which were intact.  There was no evidence of a meniscal tear and a small effusion was present in the knee joint.  A left knee MRI the same day showed a probable small tear of the anterior horn of the lateral meniscus with a small effusion present.  At the C&P examination, the CI’s gait was normal as was bilateral knee ROM; there was painful motion, but no loss of motion with repetition.  The CI was treated for hypertension with benazepril (angiotensin-converting enzyme inhibitor), although his blood pressure was 152/89 and 133/90 at the NARSUM and C&P examinations, respectively.  Intermittent esophageal reflux was treated with rabeprazole (proton-pump inhibitor), and a bilateral visual deficit of 20/50 was corrected to 20/20 with glasses.  Panel members agreed 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 chronic low back pain and IAW VASRD §4.59, the panel recommends no change in the PEB adjudication.  In the matter of the contended retropatellar pain syndrome, hypertension, esophageal reflux disorder and correctable vision 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.  

AR20190005810, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	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.

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