RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-005442
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20090323

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, OH-58 Armament/Electrical/Avionics Systems Repairer, medically separated for “right sacroiliac joint dysfunction” with a disability rating of 10%.

CI CONTENTION:  The CI contends his injuries continue to worsen and negatively impact his daily activities and requested review of two conditions determined to be not unfitting (plantar fasciitis and degenerative disc disease).  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 – 20081211	VARD – 20090414	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Sacroiliac Joint Dysfunction	5236	10%	Right Sacroiliac Joint Dysfunction	5239	NSC	20090129	
Plantar Fasciitis	Not Unfitting	No VA Placement	
Lumbar Degenerative Disc Disease	Not Unfitting 	Lumbar Degenerative Disc Disease	5243	0%	20090129	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Sacroiliac Joint Dysfunction.  According to the service treatment record and MEB narrative summary (NARSUM), the CI first experienced hip and lower back pain in February 2006 with no specific injury or trauma.  However, the CI completed two parachute jumps the same month prior to becoming symptomatic.  Plain films of the pelvis obtained on 21 June 2006 were normal.  An MRI of the lumbar spine on 1 August 2006 showed a broad based disc bulge at L5-S1 which approximated bilateral exiting L5 nerves.  A repeat MRI on 24 June 2008 demonstrated mild degenerative disc disease of L5-S1 without significant protrusion.  

The 15 September 2008 MEB NARSUM examination, 6 months prior to separation, noted complaints of constant pain in the right posterior hip/pelvis, rated 2/10 with flares to 8/10 twice a week.  Physical examination showed a normal gait.  There was “some loss” of the normal lordosis with tense spasms.  The right iliac crest appeared slightly lower that the left.  Sensation, reflexes and strength were normal.  The examiner referred to the formal range of motion (ROM) examination done by physical therapy (PT) below.  

The 20 October 2008 PT ROM examination, 5 months prior to separation, showed thoracolumbar spine flexion of 90 degrees (normal) and combined ROM of 230 degrees (normal 240), after repetition, with pain in some planes of motion.  Right hip ROM was flexion of 103 degrees (normal 125), extension of -5 degrees (normal 20) and abduction of 25 degrees (normal 45). 

At the 29 January 2009 VA Compensation and Pension (C&P) evaluation, 2 months before separation, the CI reported stiffness and loss of flexibility in the right hip and buttock with pain severity of 3/10 elicited by physical activity.  Her low back symptoms were stiffness and 2/10 pain, which was constant and aching.  She denied any incapacitation or bedrest.  Physical examination showed a normal posture and gait.  Thoracolumbar spine ROM was flexion of 90 degrees and combined ROM of 240 degrees.  There was no evidence of painful motion, muscle spasm or tenderness.  Pain, weakness, lack of endurance, fatigue and incoordination had no impact on the ROM after repetitive use.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right sacroiliac joint dysfunction 10%, coded 5236 (sacroiliac injury and weakness), citing forward flexion of 90 degrees and a combined ROM of 220 degrees.  The VA found the right sacroiliac joint dysfunction to be not service connected and did not rate it.  However, the VA did rate the back condition at 0%, coded 5243 (intervertebral disc syndrome), based on the C&P examination citing normal ROM and no incapacitating episodes.  In this case, the low back pain and sacroiliac joint dysfunction are closely related conditions.  IAW VASRD §4.66 (sacroiliac joint), which stipulates, “The lumbosacral and sacroiliac joints should be considered as one anatomical segment for rating purposes,” the panel considered the back condition and sacroiliac joint dysfunction together for fitness and rating determinations.

The panel agreed that a 10% rating, but no higher, was justified for a combined ROM greater than 120 degrees but not greater than 235 degrees, as reported on the MEB PT examination.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour proximate to separation, thus the next higher 20% rating was not justified on this basis.  There was no evidence of intervertebral disc syndrome which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula for that condition.  Rating the condition as hip limitation of motion was considered, but would not have been beneficial to the CI.  After due deliberation, considering all of 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 right sacroiliac joint dysfunction. 

Contended PEB Conditions:  Plantar Fasciitis and Mild Degenerative Disk Disease.  The panel agreed that any ratable factors from the mild degenerative disk disease was subsumed in the rating for the sacroiliac dysfunction as noted above.  In regards to the plantar fasciitis, the panel’s main charge is to assess the fairness of the PEB’s determination that the condition was not unfitting.  The plantar fasciitis was not profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the plantar fasciitis 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 the plantar fasciitis, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right sacroiliac joint dysfunction and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended plantar fasciitis condition, the panel recommends no change from the PEB determination 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.   

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170702, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180007405 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.
  
Sincerely,					      
Enclosure