RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01499
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090329

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Motor Transport Operator, medically separated “low back pain (LBP)” with a disability rating of 10%.

CI CONTENTION:  The CI contends the PEB rating was not proper, that the VA rated the same conditions higher and that the conditions continue to worsen.  The CI’s complete submission is at Exhibit A.

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited 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 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 based upon a 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 – 20081215	VARD - 20090728	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP	5243	10%	Lumbosacral Strain	5237	40%	20090515	
Headaches, Tension	Not Unfitting	Cervical Sprain with Cervicogenic Headaches	5237	20%	20090515	
Cervicalgia	Not Unfitting					
Uterine Fibroids Asymptomatic	Not Unfitting	                                         No VA Placement	
Allergic Rhinitis Seasonal	Not Unfitting		
Dyshidrosis	Not Unfitting		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Chronic LBP.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s LBP condition began in July 2006 after lifting and filling sand bags during training.  Serial diagnostic X-rays remained normal.  Despite non-surgical conservative treatment, her painful low back symptoms remained and she was referred to the MEB.  
At the MEB NARSUM examination on 23 August 2008, 7 months prior to separation, the CI endorsed constant LBP described as an “ache” worsened by physical activity, heavy lifting, or prolonged standing.  Her physical examination (PE) revealed lumbosacral tenderness with full and non-painful motion of the thoracolumbar spine.  Under the heading of “Current Functional Status,” the MEB examiner stated the CI is “able to perform the activities of daily living (ADLs) without assistance.”  At the VA Compensation and Pension (C&P) examination on 15 May 2009, 2 months after separation, the CI reported continued LBP with increased flare-ups by lifting greater than 20 pounds or with prolonged standing.  Her thoracolumbar range of motion (ROM) was significantly decreased with terminal painful motion.  Back spasms were noted while performing maneuvers looking for spinal disc disorders.  Her gait, posture, and stance was normal.  In another VA (non-musculoskeletal) examination dated 10 weeks after separation, the examiner noted, the CI reported that she was “able to do her duties over the last 12 months.”  Her permanent profile dated July 2008 listed “LBP” as the sole diagnosis and allowed the activity of uninterrupted sitting for a 30-minute period.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 5243 code (Intervertebral disc syndrome), citing evidence IAW VASRD 4.10 (Functional impairment), 4.40 (Functional loss), 4.45 (The joints) and 4.59 (Painful motion).  The VA assigned a 40% rating using code 5237 (Lumbosacral strain) based on the VA C&P examination citing forward flexion of the thoracolumbar spine of 30 degrees or less.

The Board first considered the vast ROM differences between the before and after separation examinations and extensively deliberated the examination’s probative value (PV) in determining an impairment rating.  All members agreed that while both examinations held PV, the evidence of the CI’s ability to perform ADLs combined with a self-admission of duty performance prior to separation appeared inconsistent with a low back condition resulting in such severe limitation of spinal motion as documented at the VA examination.  The Board further agreed that the totality of the STR overwhelmingly supported a degree of impairment below the initial post-separation VA examination.  Absent a resulting altered gait or abnormal spinal curvature, the Board concluded that there was insufficient cause to recommend a change in the PEB’s 10% impairment rating supporting VASRD §4.59.  There was no associated unfitting radiculopathy and or evidence of intervertebral disc syndrome resulting in incapacitating episodes that could be considered for a separate rating.  

Contended PEB Conditions:  Tension headaches, cervicalgia (neck pain), asymptomatic uterine fibroids, seasonal allergic rhinitis (SAR), and dyshidrosis (blistering eczema).  The headaches, neck pain, uterine fibroids, SAR and eczema were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.  All were reviewed and considered by the Board.  There was no performance based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance.  After due deliberation, and 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 any of the above listed conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the chronic LBP condition, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended tension headaches, cervicalgia, uterine fibroids, SAR, and dyshidrosis conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  
The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140328, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

JUL 2 7 2016

MEMORANDUM FOR XXXXXXXXXXXX, 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 XXXXXXXXXXXXXXXXXXXX, AR20160010975
(PD201401499)

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