RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01578
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080814

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

CI CONTENTION: The CI contends for all conditions. 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 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 - 20080430	VARD - 20090408	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Degenerative Disc Disease of the Lumbar Spine	5242	0%	STR	
Sarcoidosis	Not Unfitting	Sarcoidosis	6846	0%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain. According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began after a fall in 2005.  He subsequently experienced intermittent, but progressive pain.  Radiographic imaging found a minimal disc bulge at L5-S1, but no other abnormalities.  There was no surgical indication.  Despite treatment, the back condition could not be adequately rehabilitated to meet the physical requirements and the CI’s was referred for an MEB.  The MEB forwarded “chronic low back pain secondary to degenerative disc disease of the lumbar spine” for PEB adjudication.

At the NARSUM evaluation on 9 April 2008, 4 months prior to separation, the CI reported pain severity of 8/10 with prolonged standing, stooping, bending, climbing and prolonged sitting.  He denied pain, numbness, or tingling that extended into his lower extremities.  Physical examination noted lumbosacral paraspinal tenderness, but no spasm.  Lower extremity neurologic findings were normal and a test for nerve root irritation was negative.  Range of motion (ROM) measurements performed by physical therapy on 15 April 2008 found thoracolumbar flexion of 90 degrees (90 normal) and combined ROM of 240 degrees (240 normal).  Painful motion was present, but there was no tenderness.  There was also no muscle spasm or guarding severe enough to cause abnormal gait or spinal contour.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 5237 code (lumbosacral strain), citing tenderness to palpation as the rationale.  The VA assigned a 0% rating using the 5242 code (degenerative arthritis of the spine).  Although a rating higher than 0% was not supported for limitation of motion, the Board agreed a 10% rating was reasonably conceded for painful motion and the variable presence of tenderness.  There was no muscle spasm or guarding severe enough to result in abnormal gait or spinal contour and a 20% rating was not justified on this basis.  There was no documentation of intervertebral disc syndrome with incapacitating episodes or evidence of ratable peripheral nerve impairment which would provide for additional ratings.  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 back condition.  

Contended PEB Condition.  The Board’s main charge is to assess the fairness of the PEB’s determination that sarcoidosis was not unfitting.  The CI developed the onset of respiratory symptoms, fatigue and weight loss in early 2006.  By the time a diagnosis of sarcoidosis was suspected in December 2006, symptoms were improved and a pulmonologist considered the condition to be spontaneously resolving.  Specific treatment was not required, but because of persistence of shortness of breath during running, he was placed on a permanent P2 profile for unlimited walking (but no running).  He successfully completed a fitness test in March 2008.  The condition was not implicated in the commander’s statement and was not judged to fail retention standards.  The sarcoidosis condition was reviewed and considered by the Board.  There was no performance-based evidence from the record that it 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 sarcoidosis condition and so no additional disability rating is recommended.  

BOARD FINDINGS: In the matter of the chronic low back pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended sarcoidosis 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 20140407, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record
SAMR-RB

JUl 272016

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 XXXXXXXXXXXXXXXXXXXX, AR20160010515 (PD201401578)

I have reviewed the enclosed Department of Defense Physical Disability Board of
Review (000 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