RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05749
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20021205

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Telecommunications Computer Operator, medically separated for “low back pain and bilateral hip pain” with a disability rating of 0%. 

CI CONTENTION:  The CI contends that his condition was not properly diagnosed.  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 - 20020802	VARD - 20021206	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Back Pain and Bilateral Hip Pain	5299-5295	0%	Degenerative Disc Disease	5293	0%	20020823	
			Sacroiliitis, Bilateral Hips	5299-5294	0%	20020823	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Back and Bilateral Hip Pain.  The PEB combined the back and bilateral hip conditions as a single unfitting condition coded analogously to 5295 (lumbosacral strain) and rated 0%.  The approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  The panel’s initial charge in this case was therefore directed at determining if the PEB’s approach of combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  The evidence for the back and bilateral hip conditions is presented below with attendant recommendations regarding separate unfitness, and separate rating if indicated.  

According to service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back and hip pain began after a hard landing during an airborne operation in September 2000.  An MRI of the thoracic and lumbar spine was essentially normal.  X-rays of the bilateral hips were normal.  In April 2002 the CI had one episode of sciatica, which was treated and resolved.  A focused physical examination by physical medicine in March 2002 showed full active range of motion (ROM) of all joints and no muscle spasms.  There was minimal tenderness over the lower spine and lateral region of the left hip.  Neurological examination was normal as was motor strength.

During the 6 June 2002 MEB examination (recorded on DD Forms 2807 and 2808) 6 months prior to separation, the CI reported chronic back pain since September 2000 with numbness to his left buttock.  At the MEB NARSUM examination that same day, the CI reported decreased left hip pain with right hip and low back pain.  Physical examination showed tenderness, but no spasms.  There was pain in buttocks and upper posterior thigh with straight leg raise testing and slight pain with axial compression in the thoracic and lumbar areas.  Strength and sensation were intact.

The 6 July 2002 physical therapy (PT) ROM testing, 5 months before separation, documented thoracolumbar flexion to 90 degrees (normal) and extension to 15 degrees (normal 30 degrees).  The ROM of the bilateral hips documented flexion of 125 degrees (normal), abduction of 45 degrees (normal), and adduction of 0 degrees (normal 25).  Painful motion was not documented.

At the 23 August 2002 VA Compensation and Pension (C&P) evaluation, 4 months before separation, the CI reported pain in his back and hips.  Physical examination showed normal posture and gait.  Examination of left and right hip was unremarkable.  Bilateral hip ROM recorded 125 degrees of flexion, 45 degrees of abduction and 25 degrees of adduction.  Painful motion was not present.  Examination of the back revealed mild levoscoliosis and no evidence of spasm.  Sensation was normal, and straight leg raise testing was negative bilaterally.  The examiner opined there was no pathology to render a diagnosis.

The panel directed attention to its rating recommendation based on the above evidence.  The 2002 VASRD was in effect at the time of separation.  The 2002 standards for rating based on ROM impairment were subject to the rater’s opinion regarding degree of severity, whereas the current standards specify rating thresholds in degrees of ROM impairment.  The PEB combined the back and bilateral hip conditions as a single unfitting condition coded analogously to 5295 (lumbosacral strain) and rated 0%.  The VA rated the back condition at 0%, coded 5293 (degenerative disc disease).  The VA combined the hips for a 0% rating, coded analogously to 5294 (sacroillitis).  

The panel’s initial charge in this case was directed at determining if the PEB’s combined adjudication was justified in lieu of separate ratings.  There was not a preponderance of evidence in the case file to show that the back, left hip and right hip conditions were not separately unfitting so the panel proceeded to the rating of each unfitting condition. 

A 0% rating for the back under code 5295 represents slight subjective symptoms only, while a 10% rating is for “characteristic pain on motion.”  The panel considered the two ROM examinations most proximate to separation, i.e., PT examination, 5 months before separation, and C&P examination, 4 months prior to separation.  The PT ROM did not address the presence or absence of painful motion, but recorded full flexion and slightly reduced extension.  The C&P examination documented normal ROM in the absence of painful motion.  The panel agreed that a 10% rating under the 5295 code was not justified based on the evidence.  There was no rating higher than the 0% adjudicated by the PEB under any applicable code (5292 or 5393).

The panel next proceeded to the rating of the right hip.  The physical medicine examination, 9 months before separation, showed full active ROM of all joints.  The C&P and PT examinations recorded full ROM.  Painful motion was not recorded, nor was there evidence of functional loss.   Tenderness was not recorded during the PT ROM or C&P examinations.  There was no radiographic evidence of degenerative joint disease of the right hip.  The panel agreed that the preponderance of evidence did not support a compensable rating under any applicable VASRD hip code (5250, 5251, 5252 or 5253) given there was no compensable loss of motion at the time of separation.  

The panel next proceeded to the rating of the left hip condition.  The panel noted the absence of left hip findings.  Tenderness to palpation was not recorded during the NARSUM, physical medicine examination or the C&P examination.  ROM was full.  There was no documentation of pain on motion, limitation of motion or functional loss.  There was no radiographic findings of degenerative joint disease.  After due deliberation, the panel concluded the record in evidence did not support the minimal compensable rating for the left hip condition under any applicable VASRD hip code and the panel agreed neither hip condition rose to a level of compensability under §4.59, §4.45 or §4.40.  

The panel noted, there was no additional benefit to the CI when the conditions were unbundled.  Therefore, after due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends no change in the PEB adjudication for the bundled back and bilateral hip conditions.

Contended PEB Condition:  Bilateral Asymptomatic Pes Planus.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition 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 condition 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 contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the back and bilateral hip condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended bilateral asymptomatic pes planus condition, the panel recommends no change from the PEB determination as not unfitting.  There were 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 20120602, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180008241, 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