RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:XXXXXXXXXXXXXXX	CASE: PD-2018-00506
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20080313

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Construction Engineer Supervisor, medically separated for “low back pain (LBP)” and “right hip 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 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 – 20080421	VARD – 20080529	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diffuse Lumbar Disc Disease (LBP)	5243	10%	Degenerative Joint Disease, Lumbar Spine	5242	10%	20080514	
Chronic Right Hip Pain…	5099-5003	10%	Bilateral Hip Strain	5255	0%		
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:

LBP. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s low back condition began after a motor vehicle accident (MVA) on 11 July 2006. An initial physical evaluation revealed a bulging and impinging disc at the S1 nerve root. The CI was referred to neurology who determined no need for surgical intervention. Her treatment regime consisted of physical therapy (PT) and chiropractic manipulation. Eventually, her back pain decreased to a tolerable state.

The 25 September 2007 MEB NARSUM examination, 6 months prior to separation, noted complaints of daily LBP which she could tolerate without medication. Her physical examination (PE) revealed spinal range of motion (ROM) of normal forward flexion, extension to 10 degrees (normal 30) and a combined ROM of 200 degrees (normal 240). There was no tenderness or spasms along the boney spine or its surrounding musculature. Sensation, motor control and strength were intact to both lower extremities.  Her gait remained normal.  At the 14 May 2008

VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported LBP. The PE revealed painful ROM with forward flexion to 80 degrees, and combined ROM of 210 degrees.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the back condition 10%, coded 5243 (intervertebral disc syndrome). The VA also rated the back condition 10%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined ROM of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees. 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) or combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the MEB, NARSUM, and VA examinations. There were no muscle spasms 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. 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.

Right Hip Pain. According to the STR and MEB NARSUM, the CI’s right hip condition began after the previously mentioned MVA in July 2006. An extensive diagnostic work-up found no definitive pathology to explain her hip pain. She eventually received PT and chiropractic care for her hip pain, but she continued to have hip issues.

The MEB NARSUM examination noted complaints of intermittent right hip pain which occurred while walking. At the onset of pain, relief was obtained by lying down, applying ice and taking ibuprofen. Her PE revealed normal right hip flexion and decreased abduction to 32 degrees (normal 45). X-ray of pelvis and both hips taken on 14 April 2008, one month after separation, were reported as normal. No osteoarthritic changes were seen and bone texture appeared normal. However, it was additionally noted that the labrum of both hips were “sub-optimally” evaluated on this radiologic study. At the 14 May 2008 VA C&P examination, the CI reported bilateral hip pain. Her PE revealed tenderness and “popping” of both hips. Both hips were equivalent in ROM measurements noting flexion to 115 degrees (normal 125) and abduction to 30 degrees.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right hip condition 10%, analogously coded 5003 (degenerative arthritis) citing non- compensable limitation of motion and additional functional loss with repeated use and flare-ups. Additionally, the PEB noted that the (hip) clinical history was consistent with a labral tear. The VA rated the (bilateral) hip condition 0%, coded 5255 (femur, impairment), based on the C&P examination, citing non-compensable evaluation is assigned unless there is malunion of the femur with slight knee or hip disability. Although there was no evidence of functional loss nearest to separation that supported a 10% rating (based on §4.40 and §4.45), all panel members agreed that the PEB’s 10% impairment rating was justified and supported by §4.59 (painful motion). The pre-separation examinations did not demonstrate any further impairment to the adjacent femur bone as to support a higher rating under the code 5255. After due deliberation, considering all the evidence and mindful of VASRD §4.3, the panel concluded there was insufficient cause to recommend a change in the PEB’s adjudication for the right hip condition.

BOARD FINDINGS: In the matter of the low back condition and IAW VASRD §4.71, the panel recommends no change in the PEB adjudication. In the matter of the right hip condition and IAW VASRD §4.59, 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.

The following documentary evidence was considered:

AR20200004375, XXXXXXXXXXXXXX. 

Dear XXXXXXXXXXXXX:

	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.