RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05836
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20081029

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

PEB - 20080822	VARD - 20090407	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Hip Pain	5009-5003	10%	Degenerative Arthritis of the Hip	5251-5010	NSC	20090205	
Chronic Low Back Pain	5299-5237	10%	Lumbago	5299-5237	10%	20090205	
Irritable Bowel Syndrome	Not Unfitting	Irritable Bowel Syndrome	7319	0%	20090205	
Dyslipidemia	Not Unfitting	No VA Placement	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Left Hip Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s left hip condition began in October 2006 while serving as a HUMVEE turret gunner without specific injury or trauma noted.    The 7 May 2008, physical therapy (PT) clinic examination, 6 months prior to separation, noted complaints of left hip pain, which was described as a constant ache that occasionally became sharp.  Physical examination showed a moderately antalgic gait.  There was good lumbar pelvic alignment.  Range of motion (ROM) was within normal limits.  X-rays showed a normal left hip.

The 30 June 2008, PT clinic appointment, 4 months prior to separation, noted complaints of left hip pain.  Physical examination showed a normal gait.  The ROM was normal with pain noted on flexion.  An MRI of the left hip was negative.  The 29 July 2008, orthopedic spine clinic evaluation, 3 months prior to separation, noted complaints of left hip pain.  Physical examination showed some pain with flexion and internal rotation of the left hip.  Otherwise, the CI’s neurological examination was normal.  The examiner stated the CI obtained good relief with activity modification. 

The 8 August 2008 MEB NARSUM examination, 3 months prior to separation, noted complaints of chronic left hip pain.  Physical examination showed no abnormal gait.  The lower extremities were essentially normal for size, shape and symmetry.  The ROM was flexion of 65 degrees (normal 125), abduction of 26 degrees (normal 45) and extension of 20 degrees (normal).  Neurological examination was intact.  X-rays and MRI were normal.  

At the 2 February 2009 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported a gradual onset of pain, which was aggravated by prolonged standing or sitting.  Physical examination showed a normal gait and strength.  Flexion was 100 degrees, abduction was 45 degrees and extension was 20 degrees.  Neurologic and Vascular examination was normal.  X-rays revealed a normal left hip.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left hip condition 10%, coded analogously to 5003 (degenerative arthritis), citing painful motion IAW VASRD 4.59.  The VA found the left hip condition to be “not service connected,” coded 5251-5010 (thigh, limitation of extension analogous to traumatic arthritis), based on the C&P examination.  There was no compensable limitation of motion for consideration under 5251 or 5252.  There was no evidence of disability for consideration of rating under 5250, 5253, 5254 or 5255.  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 left hip condition.  

Chronic Low Back Pain.  According to the STR and the MEB NARSUM, the CI’s low back condition began in July 2004 while training at the U.S. Army Airborne School during extensive physical training.  An MRI of the lumbar spine was normal.  The 7 May 2008 physical therapy clinic examination, 6 months prior to separation, noted complaints of low back pain.  Physical examination showed an antalgic gait.  There was good lumbar pelvic alignment.  Tenderness was reported.  ROM was normal except for the trunk, which was decreased due to pain.        

The physical therapy clinic examination noted complaints of low back pain.  Physical examination showed a normal gait.  There was tenderness and increased tone of the lower thoracic spine paraspinals noted.  ROM was normal, but pain was noted with flexion.  The orthopedic spine clinic examination showed normal back and neurological examinations.  MRI of the low back was normal.  The examiner noted the CI obtained good relief with activity modification.    

The MEB NARSUM examination noted complaints of chronic back pain.  Physical examination showed no abnormal gait.  Tenderness was present.  There was no guarding, fasciculations or spasms.  There was no scoliosis or significant kyphosis.  Thoracolumbar ROM measurements showed flexion of 80 degrees (normal 90) and combined ROM of 210 degrees (normal 240) after repetition.  Neurologic and vascular examinations were intact.  X-rays were normal.  

At the C&P evaluation the CI reported daily back pain, which became worse with prolonged sitting or standing.  Physical examination showed a normal gait and there was no guarding, spasm or tenderness.  Thoracolumbar ROM measurements showed flexion of 90 degrees and combined ROM of 240 degrees after repetition, and associated with painful motion.  Straight leg raise test was negative, strength was 5/5 and vascular examination was intact.  Imaging suggested very mild narrowing of the L5-S1 disc space.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded analogously to 5237 (lumbosacral strain), citing tenderness, “forward flexion at 86 degrees” and painful motion.  The VA also rated the back condition 10%, coded 5299-5237, based on the C&P examination, citing painful motion and functional loss.  The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion greater than 60 degrees but not greater than 85 degrees and combined ROM greater than 120 degrees but not greater than 235 degrees, as reported on the MEB 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 incapacitating episodes which would provide for a higher rating under the intervertebral disc syndrome formula.  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 back condition.  

Contended PEB Conditions:  Irritable Bowel Syndrome (IBS) and Dyslipidemia.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  Neither of the conditions were profiled, implicated in the commander’s statement or judged to fail retention standards.  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 either of the contended conditions and so no additional disability ratings are recommended.  

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

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170809, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180008253, 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