RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01640
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070122

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated Reserve E5, Motor Transport Operator, medically separated for “low back pain without neurologic abnormality” with a disability rating of 10%.  

CI CONTENTION:  The CI contends for a higher rating for her conditions.  The applicant’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 - 20061205	VARD - 20070618	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain without Neurologic Abnormality	5299-5237	10%	Chronic Back Pain	5237	Non Service Connected (NSC)	20070309	
Bilateral Carpal Tunnel Syndrome (CTS)	Not Unfitting	Residual, Left Wrist Post Carpal Tunnel Release of Median Nerve	8599-8515	0%	20070309	
		Scar, Left Hand, …	7804	0%	20070309	
		Residual, Right Wrist Post Carpal Tunnel Release of Median Nerve	8515	0%	20070309	
		Scar, Right Hand, …	7804	0%	20070309	
Neck Pain	Not Unfitting	Chronic Neck Pain	5299-5237	NSC	20070309	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Chronic Back Pain without Neurologic Abnormality.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in 2001 after falling from a repelling tower.  The CI developed back pain with radiation into the hips.  X-ray of the lumbar spine done in March 2005 was normal; however, a lumbar spine Magnetic Resonance Imaging (MRI) done in March 2005 showed minimal osteophytes at the L5-S1 level.  X-ray of the thoracic spine in April 2005 showed early degenerative joint disease at the T-10 level and a thoracic MRI done in June 2005 was normal.  Electrodiagnostic studies (EMG/NCV), done in late 2005, were reported as negative for lumbar radiculopathy.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “low back pain” for PEB adjudication.  

At the MEB examination (recorded on DD Form 2808) dated 26 September 2006 approximately 4 months prior to separation, the examiner documented tenderness (thoracic and lumbosacral, as well as rhomboid (thoracic/shoulder blade muscles), and range-of-motion (ROM) was pain-limited to forward flexion of 70 degrees (normal 90) and combined 175 degrees (normal 240).  Gait was normal and lower extremity strength, sensation and reflexes were normal.  Provocative maneuvers for signs of radiculopathy or radiating pain due to spinal nerve root or sciatic nerve involvement were negative.  The MEB NARSUM examination on 27 September 2006 approximately 4 months prior to separation noted complaints of back pain that radiated bilaterally into the pelvis and some tingling sensation into both feet.  There were functional limitations of an inability to wear Kevlar or body armor and an inability to sit for an extended period of time.  The physical examination portion referred to the MEB examination (DD Form 2808).  

At the VA Compensation and Pension (C&P) examination in March 2007, performed approximately 2 months after separation, the CI reported that her whole back hurt and the pain was exacerbated by standing, walking, sitting, lifting and leaning forward.  On examination, lower extremity strength, sensation and reflexes were normal.  Gait and posture were normal.  Provocative straight leg lift (for signs of radiculopathy) was negative.  The back was not tender to palpation.  The examiner indicated that the CI’s movement in the examination room indicated rotation and lateral flexion to 30 degrees (normal) and forward flexion of at least 45-50 degrees, but that the CI “refused to do any of the ROM exercises …” and that on ROM testing would only flex to approximately 30 degrees.  The CI “refused to do repeat ROM in any form.”  The examiner’s diagnosis was normal lumbar spine.   

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5237 code (lumbosacral strain), citing pain limited motion with localized tenderness.  The VA determined the condition was NSC using the 5237code based on the VA C&P examination approximately 2 months after separation, citing no evidence of a current diagnosis.  

The Board agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) and combined ROM (greater than 120 degrees but not greater than 235 degrees) reported on the NARSUM examination proximate to separation.  There was no muscle spasm or guarding severe enough to result in abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  

There was no associated radiculopathy for separate peripheral nerve rating.  While the CI may have experienced radiating pain from the back condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  There was no objective evidence of a radiculopathy with functional impairments such as weakness with a direct impact on fitness that were separately functionally impairing for duty.  An EMG was negative for radiculopathy.  The Board therefore concluded that additional disability rating was not justified on this basis.  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.  

Contended PEB Conditions.  

Bilateral CTS.  The bilateral CTS condition was not profiled however the commander’s statement mentioned that the CI had bilateral arm and hand pain.  Although the commander stated that her limitations prohibited her from lifting over 10 pounds, he did not specify what conditions he was referring to.  At the MEB NARSUM examination the CI reported resolution of her CTS symptoms following surgical repair (February and July 2006); however she reported some discomfort over her incision site which prevented her from putting any pressure on this area.  The MEB examiner noted minimal tenderness at the incision site.  The VA C&P examiner noted a bilateral negative Tinel’s sign, and no indication of pain, weakness or fatigue with ROM.  The bilateral CTS condition was reviewed and considered by the Board.  There was no performance-based evidence from the record that this condition significantly interfered with satisfactory duty performance at separation.  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 bilateral CTS contended condition and so no additional disability rating is recommended.  

Neck Pain.  The neck pain condition was not profiled nor mentioned in the commander’s statement.  At the MEB NARSUM examination, the CI reported neck pain that began in the midline and radiated out to the trapezius muscles.  There was diffuse cervical spine tenderness however there were no findings of painful ROM or pain limited ROM.  The CI reported that she was unable to wear Kevlar or body armor due to the discomfort in her neck and back, however the examiner documented that “there is no letter form the commander to substantiate these details.”  The VA C&P examiner noted that with distraction, the CI had full cervical ROM without any painful motion and he diagnosed a normal cervical spine.  The neck pain condition was reviewed and considered by the Board.  There was no performance-based evidence from the record that this condition significantly interfered with satisfactory duty performance at separation.  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 neck pain contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the back condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended bilateral CTS and neck pain 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, 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 20140408, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

28 JUL 2016

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, AR20160007462 (PD201401640)

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