RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01711
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060908

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E6, (CH-47 Helicopter Repairer), medically separated for “low back pain (LBP) with lumbar intervertebral disk degeneration with intervertebral bulging disks” with a disability rating of 0%.

CI CONTENTION:  The CI contended for his back condition and hypertension.  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 - 20060818	VARD - 20061109	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain with Lumbar Intervertebral Disk Degeneration…	5242	0%	Lumbar Spondylosis with Disc Disease…	5239	10%	20060719	
Essential Hypertension	Not Unfitting	Hypertension	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM) the CI’s LBP condition began in 1998 after performing physical training and was aggravated in a motor vehicle accident in 2004.  He continued to have back pain with an increased inability to function in his MOS.  Diagnostic imaging performed 7 months prior to separation revealed multi-level degenerative disc disease (DDD) about the lumbosacral spine.  He was given a L3 profile and referred to a MEB.  The MEB forwarded Intervertebral disk degeneration, lumbar, with intervertebral bulging disks to the PEB for adjudication.
 
At the MEB NARSUM examination on 8 August 2006, 1 month prior to separation, the CI reported continued LBP with intermittent radicular pain extending into the back of his left thigh.  His physical examination (PE) (referenced as to the VA examination [July 2006]; 2 weeks prior to the NARSUM) revealed a normal appearing lumbar spine and a normal gait.  There was painful and decreased range of motion (ROM) of the thoracolumbar spine noting flexion to 70 degrees (normal = 90) and extension to 10 degrees (normal = 30).  The combined ROM was 175 degrees.  There was no spasm or local tenderness present.  Motor and sensory parameters were intact.  Three days after the NARSUM examination, there was a PT evaluation that revealed significantly worsened thoracolumbar ROM, with measurements obtained by an inclinometer.  VASRD guidelines call for goniometric measurements as the standard for rating an impairment.  Therefore, the Board attached considerably less probative value to the PT evaluation in making its final rating recommendation.   

The ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Thoracolumbar ROM
(Degrees)	MEB-PT ~6 Mo. Pre-Sep
(20060307) 	VA C&P ~2 Mo. Pre-Sep
(20060719) 	
Flexion (90 Normal)	40	70	
Combined (240)	-	175	
Comment	painful motion	-	
§4.71a Rating	20%	10%	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB assigned the low back condition a 0% rating coded 5242 (degenerative arthritis), citing painful motion.  The VA assigned a 10% rating coded 5239 (spondylolisthesis…’spinal slippage’) based on the C&P examination, citing limited motion.  All Board members agreed that the NARSUM referenced VA examination near the time of separation clearly supported a 10% rating based on the combined ROM of the thoracolumbar spine.  Additionally, there was no muscle spasm or guarding to cause an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  Additionally, 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 recommends a disability rating of 10% for the low back condition. 

Contended PEB Condition.  The Board’s main charge is to assess the fairness of the PEB’s determination that essential hypertension was not unfitting.  The hypertension condition was not profiled or implicated in the commander’s statement and was not judged to fail retention standards.  The condition was reviewed and considered by the Board.  There was no performance based evidence from the record that the hypertension condition significantly interfered with satisfactory duty performance.  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’s fitness determination for essential hypertension and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the chronic LBP condition, the Board unanimously recommends a disability rating of 10%, coded 5242 IAW VASRD §4.71a.  In the matter of the contended essential hypertension condition, the Board unanimously recommends no change from the PEB’s determination as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Low Back Pain with Lumbar Intervertebral Disk Degeneration 	5242	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140422, 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 XXXXXXXXXXXXXXXXXXXXX, AR20160013477 (PD201401711)

1. 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,
accept the Board’s recommendation to modify the individual’s disability rating to 10%
without re-characterization of the individual’s separation. This decision is final.

2. I direct that all the Department of the Army records of the individual concerned be
corrected accordingly no later than 120 days from the date of this memorandum.

3. I request that a copy of the corrections and any related correspondence be provided
to the individual concerned, counsel (if any), any Members of Congress who have
shown interest, and to the Army Review Boards Agency with a copy of this
memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

CF:
( ) DoD PDBR
( ) DVA