RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE:  PD-2014-00622
BRANCH OF SERVICE:  Army		SEPARATION DATE:  20050828

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E6, Counterintelligence Agent, medically separated for “chronic back pain with L4-5 herniated nucleus pulposus without significant neurologic or electrodiagnostic abnormality” and “chronic pain due to right inferior pubic stress fracture,” rated 10% and 10%, respectively, with a combined disability rating of 20%.

CI CONTENTION:  The CI elaborated no specific contention in his application.

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the PEB to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the Physical Evaluation Board (PEB), but determined to be not unfitting.  Any conditions outside the Board’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.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.

RATING COMPARISON:

SERVICE PEB - 20050516	VARD – 20051213	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain w/L4-5 HNP…without Significant Neurologic or Electrodiagnostic Abnormality	5243	10%	DDD Lumbar Spine	5242	10%	20050603	
Right Inferior Pubic Stress Fracture	5099-5003	10%	Pubic Stress Fracture	5099-5003	0%	20050603	
COMBINED RATING:  20%	COMBINED RATING FOR ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Chronic Low Back Pain.  The Medical Evaluation Board (MEB) narrative summary (NARSUM) of 29 March 2005 (5 months prior to separation) indicated that the CI injured his back in 2002.  His symptoms included low back pain (LBP) and occasional numbness in his legs and toes.  Radiographs revealed lumbar degenerative disc disease (DDD) as well as lumbar disc protrusion with nerve root compression.  Despite non-surgical treatment to include injections, his LBP continued and was referred to an MEB.  The MEB physical examination noted a slight limp to his gait.  There was low back tenderness present.  Motor strength was normal and there was decreased sensation along the outside of his lower right leg.  Thoracolumbar range-of-motion (ROM) was decreased and there was no comment with regards to painful motion with active movement.

At the VA Compensation and Pension (C&P) examination (performed 3 months prior to separation) the CI reported a constant 8 of 10 sharp LBP with extension into both legs.  The pain was aggravated by physical activities or prolonged positioning and relieved with rest.  The CI denied having episodes of incapacitation.  His VA physical exam revealed normal muscle strength and a normal gait.  ROM of the thoracolumbar spine was full with painful endpoints.  There was no evidence of radicular pain with movement, lumbar tenderness, or spasms.  L5 and S1 sensory deficit was noted on the outside aspect of both feet.  The VA’s diagnosis was DDD with intervertebral disc syndrome (IVDS) of L5 and S1.

The Board directed its attention to its rating recommendation based on the above evidence.  Board members first concluded that although both the MEB and VA examinations were clinically in-depth and detailed, a greater probative value was apportioned to the VA exam due to its close reference to the CI’s DOS.  Absent compensable ROM parameters, Board members agreed that VASRD §4.59 (painful motion) was sufficiently supported for a maximum of 10% rating impairment.  The Board additionally considered if the symptomatic sensory deficit on the outside of both feet warranted an additional disability rating; but, members consensus was that the requisite link of the neuropathy symptoms with functional impairment was not in evidence as seen by the maintenance of a normal gait, normal lower extremity strength, and full ROM of the lower back.  Any extending pain component of a radiculopathy is subsumed under the general spine rating as specified in §4.71a.  The Board concluded therefore that any radiculopathy/neuropathy symptom could not be recommended for additional disability rating.  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 10% for the chronic back pain condition was appropriately recommended in this case.

Pelvic Stress Fracture.  Pursuant to chronic right upper groin pain since 2002 a magnetic resonance image (MRI) of the pelvis performed in 2004 revealed a right-sided stress fracture of the inferior pubic bone.  There were no other pelvic or hip abnormalities seen on the scan.  Due to persistent complaints of right pelvic pain with extension into the right hip, the CI was permanently profiled with a listed diagnosis of ‘stress fracture medial inferior right pubic bone’ as one of two orthopedic diagnoses.  His MEB PE noted decreased and painful motion of the right hip.  At the VA C&P examination, the CI endorsed a constant right-sided pubic bone pain greatest with prolonged walking and strenuous exercise.  His physical exam revealed tenderness about the pubic bone.

The Board directed its attention to its rating recommendation based on the above evidence.  Both the PEB and VA rated the stress fracture condition under the same VASRD code, but cited different rating impairments.  The PEB rated 10% citing the presence of slight pain, whereas the VA rated 0%.  Board members agreed that the pathology and clinical relevance present near the time of separation did not support any degree of impairment greater than the PEB’s current 10%; this included evidence of tenderness, painful motion, or limited ROM of extension (code 5251) or an inability to cross legs at 18 degrees of hip adduction (code 5253).  There were no other codes available within VASRD §4.71a that were applicable to the CI’s diagnosis or disability nor documentation of incapacitating episodes which would provide for additional or higher rating.  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 10% for the pubic stress fracture condition was appropriately recommended in this case.

BOARD FINDINGS:  In the matter of the low back condition, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the right pubic stress fracture condition, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that 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 20131101, 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 XXXXXXXXXXXXXXXXXX, AR20160005581 (PD201400622) 

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA