RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE: PD-2013-00288
BRANCH OF SERVICE:  Army	BOARD DATE:  20141119
SEPARATION DATE:  20061114

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PV2/E-2 (92G10/Food Service Specialist) medically separated for back and left Achilles pain.  The conditions could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards.  She was issued a permanent L3S1 profile and referred for a Medical Evaluation Board (MEB).  The back and leg conditions, characterized as “lumbago” and “Achilles tendonitis” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “chronic back pain without neuralgic abnormality” and “left Achilles tendonitis without ratable limitation of motion,” rated 10% and 0% respectively.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Occasionally I still experience some back pain.  Recently I fell off a horse an experienced back & hip pain.”

SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB, when specifically requested by the applicant.  The ratings for conditions meeting the above criteria are addressed below.  In addition, the Secretary of Defense directed a comprehensive review of Service members with certain mental health conditions referred to a disability evaluation process between 11 September 2001 and 30 April 2012 that were changed or eliminated during that process.  The applicant was notified that he may meet the inclusion criteria of the Mental Health Review Terms of Reference.  The mental health condition was reviewed regarding diagnosis change, fitness determination and rating in accordance with VASRD §4.129 and §4.130.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, may be eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Service IPEB – Dated 20061017	VA - (4 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5299-5237	10%	Chronic Low Back Strain	5237	10%	20070315	
Lt Achilles Tendonitis	5024	0%	Recurrent Lt Ankle Achilles Tendonitis	5099-5024	10%	20070315	
No MH Condition	Depression; Stress; Insomnia	9434	NSC	20070226	
Other x 0 (Not In Scope)	Other x 12	
Combined:  10%	Combined:  30%	
Derived from VA Rating Decision (VARD) dated 20080221 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Low Back Condition.  The CI presented with insidious onset of lower back pain in 2005.  She was treated with pain medications, activity modification and physical therapy without relief.  A treatment note dated 22 February 2006 documented reported lower back pain with left lower extremity radiation.  The physical examination was significant for full range-of-motion (ROM) and right greater than left paravertebral tenderness to palpation (TTP).  Radiographic evaluations (X-rays and magnetic resonance imaging studies) were normal.  A diagnosis of lumbago (mechanical low back pain [LBP]) was rendered.  An orthopedic evaluation dated 9 June 2006 noted the CI was not a candidate for surgical intervention.  At the narrative summary (NARSUM) examination dated 22 August 2006, the CI reported a constant 6/10 on a pain scale.  The pain was aggravated by prolonged standing and lifting greater than 30 pounds.  When aggravated, the pain was reported as 8/10.  The CI was on Ultracet for pain and Flexeril for muscle spasms.  The physical examination was significant for lumbar paraspinous tenderness to palpation with pain limited motion.  The gait was normal.

At the VA Compensation and Pension (C&P) examination performed 4 months after separation, the CI reported mild, weekly back pain.  The physical examination was significant for lumbar paraspinous TTP with painful motion.  The gait was normal and there was no evidence of spasms, atrophy or guarding.  A diagnosis of chronic intermittent LBP was rendered.

The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Thoracolumbar ROM
(Degrees)	MEB(PT)~4 Mo. Pre-Sep
	VA C&P ~ 4 Mo. Post-Sep
	
Flexion (90 Normal)	80	90	
Combined (240)	220	240	
Comment	Painful motion	Painful motion	
§4.71a Rating	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB adjudicated the chronic back pain without neurologic abnormality as unfitting.  The PEB and VA assigned a 10% disability rating for the chronic LBP condition; coded as 5237 analogous to lumbosacral strain.  The Board considered if there was evidence for a higher than 10% disability rating.  There was no evidence of thoracolumbar forward flexion less than 60 degrees, a combined ROM less than 120 degrees, abnormal gait, or abnormal spinal contour for a 20% rating.  There was no evidence of an unfitting radiculopathy for an additional disability rating.  After due deliberation, considering all of the evidence and mindful of VA Schedule for Rating Disabilities (VASRD) §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the chronic back pain without neurologic abnormality condition.

Left Achilles Condition.  Treatment records indicate the CI had a history of left Achilles tendonitis prior to her April 2005 reenlistment.  “Upon return to service she received a waiver evaluation and was found fit with no limitations on her physical profile.”  The NARSUM dated 22 August 2006 noted her left Achilles tendonitis remained relatively stable and without significant problems.  The left foot and ankle examination was normal.  At the VA C&P examination performed 4 months after separation, the CI reported left heal pain that was intermittent with periods of remission.  The pain was worse with standing and alleviated by application of Equate muscle rub.  The foot and ankle examination was normal.

The Board directd attention to its rating recommendation based on the above evidence.  The PEB adjudicated the left Achilles tendonitis as unfitting with a 0% disability rating for non-compensable limitation of motion.  The VA rated the recurrent left ankle Achilles tendonitis at 10% analogous to tenosynovitis, coded 5099-5024.  The Board considered if there was evidence for a rating higher than the 0% disability rating at the time of separation.  The left Achilles tenonitis was permanently profiled P2 under L that limited her to the Army Physical Fitness Test walk instead of the run.  There were treatment notes documenting reports of pain with use and objective findings of tenderness to palpation; however, treatment notes most proximate to separation documented no reports or objective findings of pain.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded there was insufficient cause to recommend a change in the PEB adjudication for the left Achilles tendonitis condition.  The Board concluded therefore that this condition could not be recommended for additional disability rating.

Contended PEB Conditions.  The Board reviewed the records for evidence of inappropriate changes in diagnosis of an MH condition during processing through the Disability Evaluation System (DES).  Although there was a history of atypical depression listed on the NARSUM it was also noted that the symptoms were controlled by medication and counseling.  The DD Form 2807 listed depression, stress and lack of sleep; and the DD Form 2808 did not list any MH diagnosis.  The evidence of the available records shows that at the time of processing through the DES there were no MH diagnoses forwarded by the MEB or adjudicated by the PEB; therefore, no MH diagnoses were changed to the CI’s possible disadvantage.  The applicant did not appear to meet the inclusion criteria in the Terms of Reference of the MH Review Project.  The panel noted that there was limited pre-separation evidence an MH disorder.  An MH condition was not permanently profiled nor implicated in the commander’s statement.  There was no indication from the record that any MH condition significantly interfered with satisfactory duty performance.  All panel members agreed that the preponderance of evidence did not support an unfit determination for any MH disorder.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the chronic back pain without neurologic abnormality condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the MH review, the Board unanimously agrees that there were no unfitting MH conditions and none could be recommended for additional disability rating.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board therefore recommends there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 201300288, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

				

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXX, AR20150006255 (PD201300288)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						     
						         
CF: 
(  ) DoD PDBR
(  ) DVA