RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01647
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090630

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Operating Room Specialist, medically separated for “lumbosacral sprain” with a disability rating of 10%.

CI CONTENTION:  The CI contends her back, bladder and sleeping difficulties have increased in severity since separation.  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 - 20090403	VARD - 20090721	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Back Pain	5299-5237	10%	Degenerative Disk Disease	5243	10%	20090309	
Primary Insomnia	Not Unfitting	Anxiety Disorder (claimed as Insomnia)	9413	10%	20090309	
Incontinence	Not Unfitting 	Overactive Bladder	7542	10%	20090309	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Back Pain According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back pain condition began in the 2005-2006 timeframe while deployed to Iraq.  She was treated by family practice, physical therapy, pain and spine clinic and the primary care clinic through December 2008.  Radiographic studies of the lumbar spine showed two bulging disks with minimal degenerative disk disease (DDD) to the lower lumbosacral spine, but no significant impingement at any level.  Despite treatment, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “lumbar spondylosis” for PEB adjudication.

At the MEB examination (recorded on DD Forms 2807 and 2808) dated January 2009, 5 months prior to separation, the CI reported chronic back pain averaging 6/10 and worse with standing.  She denied pain radiation.  Physical examination showed decreased ROM and left sacroiliac tenderness.  Radicular testing was negative.

The MEB NARSUM examination on 10 March 2009 (3 months prior to separation) noted complaints of back pain, aggravated by her job requirements and intensified by high impact activities.  Physical examination showed normal curvature of the spine.  The examiner noted that the CI was able to bend forward to remove her footwear and did not require the use of log roll techniques to change positions from supine to seated and vice versa.  The MEB Physical therapy performed ROM testing on 17 March 2008 revealed flexion at 90 degrees and combined ROM 185 with pain at endpoints.

At the VA Compensation and Pension (C&P) examination on 9 March 2009, performed 3 months before separation, the CI reported constant pain at the midline of the lumbar spine radiating into the left musculature and buttocks.  Physical exam revealed normal motion with pain but without spasm, musculature atrophy, or gait abnormality.  There was tenderness of the musculature to the left of the lumbar and sciatic joint.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5299-5237 code (lumbosacral strain), citing pain and tenderness to palpation.  The VA also assigned a 10% rating using the 5243 code (intervertebral disk syndrome) based on the VA C&P examination 3 months before separation, citing imaging evidence of degeneration and localized tenderness.  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 documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula or evidence of ratable peripheral nerve impairment which would provide for additional rating.  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 pain condition.

Contended PEB Condition:  Insomnia and Incontinence.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  The contended conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.   There was no performance-based evidence from the record that the conditions 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 contended conditions and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the back pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended insomnia and incontinence 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 20140413, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

27 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 XXXXXXXXXXXXXXXXXXXX, AR20160011069 (PD201401647)

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