RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxxxxxxxxxxxxxxxxxx	CASE:  PD-2014-00788
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060707

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Utility Equipment Repairer ) medically separated by the Informal Physical Evaluation Board for “chronic low back pain” with a combined disability rating of 10%.

CI CONTENTION:  The CI contended for his spine injury, a hand injury and his high blood pressure.  His complete submission is at Exhibit A.

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 when specifically requested by the CI, those conditions identified by the 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 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 - 20060328	VARD - 20070521	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Lumbar Strain	5237	20%	20070512	
Systolic Hypertension	Not Unfitting	No VA Claim or Rating	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Lumbar Spine.  The narrative summary (NARSUM), supplemented by the outpatient service treatment record (STR), documents an onset of low back pain with lifting in 2005, which persisted despite conservative treatment and temporary profiles.  Mild degenerative disc disease (L4/5 and L5/S1 without neural compromise) was diagnosed.  No persistent radicular symptoms were documented in the STR, and subjective weakness or sensory symptoms were denied.  There were multiple STR entries documenting normal neurological findings (5/5 strength), with none to the contrary, and surgery was not recommended.  There were STR entries documenting either grossly normal or non-specifically decreased range-of-motion (ROM), with none indicating significant ROM limitation.  The MEB’s DD Form 2808 documented “slightly limited ROM throughout.”  There was ample STR documentation of normal gait and spinal contour, with none to the contrary, and no STR documentation of incapacitating episodes.  

The NARSUM was conducted 8 December 2005 (7 months pre-separation) and documented back pain rated 5/10 with exacerbation to 7/10 with “any physical activity and stress.”  A complaint of “occasional leg weakness” without sensory symptoms was noted, and the documented functional limitations were protracted running, carrying or lifting (25 pound limit), and other general soldiering requirements.  The NARSUM physical examination recorded a normal gait and spinal contour, tenderness and spasm, and normal strength and neurological findings.  The NARSUM addendum referenced ROM measurements for the MEB by physical medicine.  These were (goniometer with 3 repetitive measurements) flexion to 90 degrees (90 normal) and combined ROM of 205 degrees (normal 240), specifying painful motion.

A VA Compensation and Pension (C&P) examination was conducted 12 May 2007 (10 months post-separation) and there was no documentation of interim injury or other exacerbation of the condition.  The examiner documented pain rated 6/10 with bilateral radiation but no subjective weakness or numbness, and noted interference with recreation and driving but “unlimited” walking tolerance.  The VA physical examination recorded normal gait and contour, the absence of tenderness or spasm, and normal neurological findings.  The VA measured ROM was flexion to 70 degrees with reduction to 60 degrees after repetitions and combined ROM of 155 degrees (140 degrees after repetition).

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating under code 5237 (Lumbar strain) was consistent with VASRD §4.71a criteria for the Service ROM evidence and other ratable findings.  The VA’s rating under the same code was premised on the DeLuca degradation of flexion to 60 degrees which is the §4.71a threshold for 20%.  There was no ROM evidence supporting a rating higher than 20%, no evidence for abnormal gait or contour to support a 20% rating, no evidence for ratable peripheral nerve impairment which would provide for additional rating; and, no documentation of incapacitating episodes which would provide for a higher rating under that formula.  The Board deliberated whether the VA evidence accommodating DeLuca considerations was probative enough to support a 20% recommendation.  Members agreed, however, that it was not; since, the outpatient STR and DD Form 2808 ROM evidence strongly corroborated the MEB ROM measurements (themselves quite credible with an experienced provider and averaged measurements), the Service ROM evidence was more temporally proximate to separation, the VA ROM limitation was not correlated with commiserate physical findings (spasm, etc.), and there was not a good clinical explanation for the deterioration in ROM between the Service and VA evaluations.  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 of the lumbar spine condition.

Contended PEB Conditions.  The NARSUM related a history of hypertension which was controlled by lifestyle modification, although the DD Form 2808 recorded a mildly elevated blood pressure (148/79) and an STR entry on the same day as the NARSUM indicated that a trial of medication was being started.  There was no evidence for any symptoms or complications attributable to the condition; and, the VA post-separation general medical C&P examination did not mention the condition, did not list any anti-hypertensive medication, and recorded a normal blood pressure.  The condition met retention standards, was not profiled, and was not implicated in the commander’s performance statement.

The Board directed attention to its recommendation based on the above evidence; and, its main charge with respect to this condition is an assessment of the fairness of the PEB’s determination that it was not unfitting.  The Board’s threshold for countering Service fitness determinations is higher than the VASRD §4.3 (Reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  Members agreed that there was no evidence for any significant impediment to fitness or ratable disability associated with hypertension in this case.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the hypertension condition; thus, it cannot be recommended for additional disability rating.

BOARD FINDINGS:  In the matter of the lumbar spine condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended hypertension condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  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 20140215, 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 XXXXXXXXXXXXXXXXXXXXXXXXXXX, AR20160002390 (PD201400788)

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