RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXX	CASE:  PD-2020-00184
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060201

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E5, Wheeled Vehicle Mechanic, medically separated for “chronic back pain” and “chronic pain, right knee, left shoulder, and bilateral foot pain,” each rated 10%, with a combined disability rating of 20%.

CI CONTENTION:  “...applied for unemployability for these conditions:  heart condition, bilateral hand condition, and bilateral wrist condition.”  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 - 20060117	VARD - 20060724	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5243	10%	S/P L5-S1 Diskectomy	5237	20%	20060525	
Chronic Pain, Right Knee	5099-5003	10%	Right Patellofemoral Syndrome	5261	10%		
Chronic Pain, Left Shoulder			Chronic Left Shoulder Pain Strain	5203	10%		
Pain, Bilateral Foot			[Left] Plantar Fasciitis	5099-5020	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic Back Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back pain became an issue in approximately 2005 with his activation to active duty and increased operations tempo and training. 

During the 15 November 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months before separation, the CI reported back pain.  The examiner documented forward flexion from “finger tips to the distal shin” (approximately with 70 to 80 degrees) with extreme pain, but provided no other measurements.  The 29 November 2005 MEB NARSUM examination noted complaints of chronic back pain status post low back surgery, and physical findings revealed use of a cane, an antalgic gait, and back tenderness.  Measured range of motion (ROM) showed flexion to 50 degrees (normal 90) and combined ROM of 180 degrees (normal 240), with painful motion elicited.   At the 16 December 2005 physical therapy examination, 2 months prior to separation, the CI used a cane and had an abnormal gait and stance.  Active lumbosacral ROM was guarded with flexion to 50 degrees; no other measurements were provided. 

During the 25 May 2006 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported low back pain after surgery.  Physical examination showed abnormal gait, use of a cane to ambulate, and lumbar spine spasms and tenderness.  Thoracolumbar flexion was to 60 degrees and combined ROM was 100 degrees, with painful motion. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, code 5242 (degenerative arthritis of the spine), citing ROM limited by pain.  The VA rated the back condition 20%, coded 5237 (lumbosacral strain), based on the C&P examination, citing limitation of flexion greater than 30 degrees but not greater than 60 degrees.  Panel members agreed that a 20% rating, but no higher, was justified for limitation of flexion, as reported on the MEB NARSUM and VA ROM examinations.  There was no evidence of intervertebral disc syndrome with incapacitating episodes to support a higher rating under that formula.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the back condition, coded 5242.

Chronic Right Knee Pain.  According to the STR and MEB NARSUM, the CI’s right knee pain began as described above for the back condition.  During the MEB examination, the CI complained of right knee pain, and the examiner noted pain with all right knee ROM except for flexion; no measurements were provided. The MEB NARSUM examiner documented reports of chronic right knee pain, and physical findings showed right knee flexion to 70 degrees (normal 140), with pain.  

During the VA C&P examination, the CI reported right knee pain for one year.  Physical examination showed an abnormal gait, use of a cane to walk, and right knee crepitus with ROM from 0-80 degrees and pain with motion. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB bundled and rated the right knee, left shoulder, and bilateral foot conditions 10%, analogously code 5099-5003 (arthritis, degenerate), citing the US Army Physical Disability Agency (USAPDA) pain policy.  The VA rated the right knee condition 10%, coded 5261 (leg, limitation of extension), based on the C&P examination, citing painful motion.  Panel members first considered whether the right knee condition remained separately unfitting, having been decoupled from the bundled left shoulder and bilateral foot conditions.  The right knee condition was profiled, implicated in the commander’s statement, and failed retention standards.  There was not a preponderance of evidence to show the right knee condition was not reasonably justified as separately unfitting, and thus the panel considered its rating recommendation for the knee at the time of separation.  While there was no compensable limitation of flexion or extension, there was objective evidence of painful motion to support a 10% rating IAW VASRD §4.59, as noted on the MEB and VA ROM examinations.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right knee condition, coded 5260.

Chronic Left Shoulder Pain.  According to the STR and MEB NARSUM, the CI’s left (non-dominant) shoulder pain began with the back and knee pain in 2005.  During the MEB examination, the CI reported left shoulder pain and the examiner recorded both shoulder flexion and abduction to 120 degrees (normal 180); painful motion was not addressed.  The MEB NARSUM examiner noted complaints of chronic left shoulder pain, and goniometrically measured ROM revealed flexion to 70 degrees and abduction to 80 degrees, with painful motion. 

During the VA C&P examination, the CI reported left shoulder pain for one year.  Upon examination, both left shoulder flexion and abduction were to 45 degrees, with painful motion. 

The panel directed attention to its rating recommendation based on the above evidence.  As noted above, the left shoulder condition was bundled with the right knee and bilateral foot conditions.  The VA rated the left shoulder condition 10%, coded 5203 (clavicle or scapula, impairment), based on the C&P examination, citing painful motion.  Upon determining whether the shoulder condition remained separately unfitting, panel members noted that it was profiled, implicated in the commander’s statement, and failed retention standards.  There was not a preponderance of evidence to show the left shoulder condition was not reasonably justified as separately unfitting, and thus the panel considered it recommendation for the unfitting shoulder condition at the time of separation.  Based on the preponderance of STR and VA ROM evidence, the VASRD §4.71a threshold for rating ROM impairment “at shoulder level” (approximately 90 degrees from the side) warranted a 20% rating.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the left shoulder condition, coded 5201.

Bilateral Foot Pain.  According to the STR and MEB NARSUM, the CI’s bilateral foot pain began in 2005 along with the other conditions discussed above.  During the MEB examination, the CI complained of left foot pain, and the examiner recorded tenderness along the medial plantar aspect of the left foot.  However, ROM and painful motion were not addressed. The MEB NARSUM examination noted complaints of chronic left foot pain and physical findings showed left foot tenderness along the plantar aspect.  Dorsiflexion was to 15 degrees (normal 20) and plantar flexion to 20 degrees (normal 45), with painful motion. 

During the VA C&P examination, the CI reported left foot plantar fasciitis and a heel spur.  The examiner recorded an abnormal gait, use of a cane, and bilateral pes planus.  There was severe left foot plantar surface tenderness, but no right foot tenderness or abnormalities.  The panel directed attention to its rating recommendation based on the above evidence.  The PEB bundled and rated the bilateral foot conditions as noted above.  The VA rated the left foot condition 10%, analogously coded 5099-5020 (synovitis), based on the C&P examination, citing painful or limited motion of a major joint or group of minor joints.  The CI did not submit the right foot for a VA disability claim.

The panel first considered whether the bilateral foot conditions remained separately unfitting, having been decoupled from the other bundled conditions.  Only the left foot was profiled, implicated in the commander’s statement, and failed retention standards.  The STR showed a negative right foot motor and sensory study, and positive imaging for a calcaneal spur and first metatarsophalangeal joint degenerative changes; however, there were no other right foot treatment records.  Panel members agreed there was not a preponderance of evidence to show the left foot condition was not reasonably justified as separately unfitting.  Accordingly, the panel considered a separate rating for the left foot condition, but determined the right foot was not unfitting.  Panel members next considered a rating recommendation for the left foot condition, and agreed a 10% rating was supported under code 5099-5020, based on documented plantar surface tenderness and painful ankle motion.  The panel considered alternative VASRD foot codes, but all were less applicable and/or not advantageous to rating.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the left foot condition, coded 5099-5020.

BOARD FINDINGS:  In the matter of the back condition, the panel recommends a disability rating of 20%, coded 5242 IAW VASRD §4.71a.  In the matter of the right knee condition, the panel recommends a disability rating of 10%, coded 5260 IAW VASRD §4.71a.  In the matter of the left shoulder condition, the panel recommends a disability rating of 20%, coded 5201 IAW VASRD §4.71a.  In the matter of the left foot condition, the panel recommends a disability rating of 10%, coded 5099-5020 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Back Pain	5243	20%	
Chronic Right Knee Pain	5260	10%	
Chronic Left Shoulder Pain	5201	20%	
Left Foot Pain	5099-5020	10%	
COMBINED	50%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20201013, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20210012013, XXXXXXX

Dear XXXXXXXXX:

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a permanent disability retirement with the combined disability rating of 50% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a permanent disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, 1835 Army Boulevard, Bldg. 2000, JBSA, Fort Sam Houston, TX. 78234

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,