RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01858
BRANCH OF SERVICE:  Army	BOARD DATE:  20140620
SEPARATION DATE:  20040719

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard SGT/E-5 (62J/Light Equipment Operator) medically separated for low back and left shoulder pain.  The conditions could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The back and left shoulder conditions, characterized as “left shoulder pain, slight/intermittent, secondary to shoulder injury” and “low back pain, slight/intermittent, secondary to lumbar strain and compression fracture of T12” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB forwarded no other conditions to the PEB.  The Informal PEB adjudicated “chronic back pain with T12 compression fracture without neurologic abnormality, combined thoracolumbar range-of- motion [ROM] of 225 degrees” and “chronic pain of left shoulder” as unfitting, rated 10% and 0%, citing use of the US Army Physical Disability Agency (USAPDA) pain policy criteria for the left shoulder pain.  The CI made no appeals and was medically separated.

CI CONTENTION:  “My condition continues worst” [sic]

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 CI.  The ratings for the unfitting back and left shoulder conditions are addressed below; no additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Service IPEB – Dated 20040527	VA - (4 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5235	10%	L5 Radiculopathy, Right Side	5243	10%	20041129	
Chronic Left Shoulder Pain	5099-5003	0%	Left Shoulder	5201-5003	10%	20041129	
No Additional MEB/PEB Entries	No Other Entries		
Combined:  10%	Combined:  20%	
Derived from VA Rating Decision (VARD) dated 20050929 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:  The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.
Chronic Back Pain Condition.  The CI experienced the onset of low back pain (LBP) in August 2003 from moving heavy equipment.  Lumbar X-rays were normal, but magnetic resonance imaging (MRI) showed a small L4-5 disc protrusion, mild degenerative disc disease at T12-L1 and a mild anterior compression fracture of T12 vertebral body.  Review of the service treatment record found prescribed bed rest amounted to less than 2 weeks.  Evaluation by a physiatrist on 30 December 2003 (6.5 months prior to separation) reported that his condition had “improved markedly with physical therapy.”  Exacerbations were “infrequent.”  Lumbar flexion was noted to be 90 degrees (normal to 90 degrees).  The CI saw a primary care provider on 25 February 2004 for a 2-day history of a LBP exacerbation.  Examination showed acute lumbar muscle spasm.  Lumbar flexion was 10 degrees and extension 0 degrees (normal 30 degrees).  The narrative summary (NARSUM) on 27 April 2004 (3 months prior to separation) reported that the CI continued to experience LBP with activity.  He could walk one mile and lift 20 pounds.  He took pain medication approximately once per week.  Examination showed a normal gait and no tenderness of the back.  ROM measurements showed flexion of 80 degrees (normal 90 degrees), extension of 25 degrees (normal 30 degrees) and bilateral flexion and rotation 30 degrees each (normal 30 degrees).  Painful motion was present.

The VA Compensation and Pension (C&P) examination performed 4 months after separation noted a normal gait and spinal contour.  Exact goniometric ROM measurements were not provided, but full flexion was stated to be lacking by “approximately 14 degrees.”  All other ROM parameters were “full.”  Tenderness was present, but there was no muscle spasm.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB cited combined thoracolumbar ROM as a rationale for a 10% rating under 5235 (vertebral fracture or dislocation).  The VA assigned a 10% rating under 5243 (intervertebral disc syndrome).  Board members concluded that limitation of motion in evidence (flexion and combined ROM) justified a 10% rating.  The Board also noted no evidence of abnormal spinal contour or gait due to thoracolumbar muscle spasm or guarding that would support the next higher 20% rating.  Although the 10 degrees of flexion noted at one exam (December 2003) could justify a higher rating, this occurred in the context of an acute exacerbation, was not reflective of the back condition’s usual state and was inconsistent with other measurements of flexion that were more proximal to the time of separation.  Board members therefore assigned little probative value to this exam.  The Board concluded that a higher rating could also not be achieved under the formula for rating intervertebral disc disease based on incapacitating episodes.  After due deliberation, considering all of the evidence and mindful of 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 condition.

Chronic Pain of Left Shoulder Condition.  The right-hand dominant CI developed left shoulder began in April 2003 due to heavy lifting and a fall.  Initial symptoms improved, but pain with activity persisted.  X-rays were normal.  MRI showed degenerative tendon changes and arthritis.  At the NARSUM exam the CI indicated that his shoulder pain was “under control” unless he performed strenuous physical activities.  At the VA C&P exam performed 4 months after separation, the CI reported “occasional discomfort” that was worse in cold weather.  Overhead activities were only bothersome if mild to moderate weight was involved.  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.

Left Shoulder ROM
(Degrees)	MEB ~ 3 Mo. Pre-Sep	VA C&P ~ 4 Mo. Post-Sep	
Flexion (180 Normal)	110	--	
Abduction (180)	110	162	
Comments	+Painful motion	+Painful motion	
§4.71a Rating	10%	10%	
The Board directs attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under an analogous 5003 code (degenerative arthritis) IAW the USAPDA pain policy.  The VA rated the condition at 10% under 5201 (limitation of arm motion).  The Board agreed that the ROM in evidence was non-compensable, but that sufficient evidence of painful motion was present to support a 10% rating IAW §4.59 (painful motion).  There was no evidence of recurrent shoulder dislocation to warrant a rating under 5202 (humerus, other impairment of).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the chronic right shoulder pain condition.

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.  As discussed above, PEB reliance on the USAPDA pain policy for rating left shoulder pain was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the chronic back pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the chronic pain of left shoulder condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Chronic Back Pain	5235	10%	
Chronic Pain of Left Shoulder	5099-5003	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131001, 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 XXXXXXXXXXXXXXX, AR20150001229 (PD201301858)

1.  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 to modify the individual’s disability rating to 20% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA