RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-05453
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20090731

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Parachute Rigger, medically separated for “chronic low back pain” and “chronic right hip pain,” rated 10% each, with a combined disability rating of 20%.

CI CONTENTION: Review requested of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB). 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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20090617	VARD - 20090929	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Fracture…L2 Vertebral Body	5299-5235	0%	STR	
Chronic Right Hip Pain	5099-5003	10%	…Right Acetabular Fracture	5299-5255	0%		
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 0%	

ANALYSIS SUMMARY:

Chronic Low Back Pain (LBP). According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s LBP began in June 2003 after a hard parachute landing, and persisted with occasional pain into the right leg. He continued airborne jumping through 2006. During a physical therapy (PT) visit on 4 January 2007, the CI reported mid to low back pain and a history of a compound L2 fracture with whiplash and a contusion. Lumbosacral spine X-rays on 2 March 2007 showed normal vertebral alignment with intact vertebral bodies and disc spaces. There was no fracture/dislocation, compression deformity, spondylolysis or spondylolisthesis, and the sacroiliac joints were normal. An MRI on 7 October 2007 revealed desiccative/protrusive disc disease and congenitally short pedicles that contributed to mild spinal and foraminal canal compromise, especially at the lumbosacral junction.

The 10 March 2009 MEB PT examination showed thoracolumbar spine flexion to 90 degrees (normal) and a combined range of motion (ROM) of 235 degrees (normal 240), with painful motion. At the 16 March 2009 MEB orthopedic consult, the CI reported LBP and the provider

noted mid thoracic and lumbar spine tenderness as well as muscle spasms. Lumbar spine flexion was 22 cm short of touching the toes (approximately 90 degrees). The 24 March 2009 MEB NARSUM examination, 4 months prior to separation, noted complaints of daily LBP, and physical examination showed lumbar spine tenderness. The CI could reach his fingertips to 3 inches from the floor (approximately 90 degrees); painful motion was elicited. At the 9 September 2009 VA primary care examination, 1 month after separation, the CI reported chronic LBP. Physical examination lumbar spine tenderness, but no spine deformity. There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the low back condition 10%, coded 5237 (lumbosacral strain), citing limitation of combined ROM. The VA rated the low back condition 0%, analogously coded 5299-5235 (vertebral fracture or dislocation), based on the STR, citing a noncompensable examination as the CI did not report to the VA examination. Panel members agreed that a 10% rating, but no higher, was justified for limitation of combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the VASRD compliant MEB PT examination proximate to separation. 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.

Chronic Right Hip Pain. According to the STR and MEB NARSUM, the CI’s right hip condition also began in June 2003 after the aforementioned hard parachute landing. Hip X-rays on 20 March 2008 were normal, and an MRI on 1 April 2008 showed no significant abnormalities. A right hip MRI arthrogram on 18 April 2008 showed an abnormal signal at the femoral head and neck junction possibly indicating a tiny erosion. Otherwise, the acetabulum labrum appeared normal.

At the MEB PT examination, repetitive right hip flexion was to 115 degrees (normal 125), extension to 10 degrees (normal 30), and abduction to 40 degrees (normal 45), with painful motion. During the MEB orthopedic consult, the CI reported constant right hip pain and an occasional popping sensation. Physical examination showed right greater trochanter tenderness, but no muscle spasm or pain over the iliotibial band areas. The MEB NARSUM examination noted complaints of chronic right hip pain. Physical examination showed exquisite pain with palpation of the right greater trochanter, good internal/external rotation with pain at the endpoints, and right hip flexor tenderness and groin pain with flexion. There was smooth hip joint movement without crunching, grating, or ratcheting. There was no inguinal hernia, but pain was present in the right groin with abduction. At the VA primary care clinic initial visit, the CI reported right hip pain, and the examiner noted no gross right hip deformity. Right hip ROM was intact with mild irritation with terminal internal rotation (painful motion). There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right hip condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing functional loss and painful motion. The VA rated the right hip condition 0%, analogously coded 5299-5255 (femur, impairment), based on the STR. Panel members agreed that while there was no limitation of extension and flexion to support a 10% rating under codes 5251 and 5252, there  was  satisfactory evidence  of painful motion  to  support  a 10% rating  IAW VASRD
§4.59, as recorded on the MEB PT, NARSUM and VA examinations. There was no hip ankylosis (code 5250), hip, flail joint (code 5254), or femur impairment (5255) to support a higher rating under those codes.  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 right hip condition.

BOARD FINDINGS: In the matter of the low back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the right hip condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. 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.

ARXXXXXXXXXXX, XXXXXXXXXXXXXXX 

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	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.