RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	 CASE:  PD-2014-01723
BRANCH OF SERVICE:  Army                                                             SEPARATION DATE:  20070330	

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve, E6, Military Police, medically separated for “chronic low back pain”, with a disability rating of 10%.  

CI CONTENTION:  The applicant contends his PTSD and sciatic nerve condition were not properly considered by the PEB.  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 - 20070212	VARD - 20070710	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5237	10%	Mild DDD, Chronic Lumbar Pain	5237	10%	20070503	
PTSD	Not Unfitting	Depression, Adjustment Disorder with Anxiety	9434	30%	20060620	
		PTSD	9411	NSC	20060620	
RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:

Chronic Low Back Pain.  According to the service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM) the CI initially sustained an injury to his back from a motor vehicle accident in 2001.   In September 2003, while on post searching a truck, he fell off the truck and re-activated his back injury with return of back pain.  The CI sought medical care and was diagnosed with lumbar sprain which was treated conservatively.  In October 2003, he fell again and was again diagnosed with a sprain which was treated with profile and non-steroidal and narcotic medications. The CI noted some improvement with the use of the narcotic agent.  Magnetic resonance imaging accomplished in August 2006 demonstrated minimal foraminal narrowing affecting left exiting L5 root, without evidence of compression or focal disk protrusion.  Due to the inadequate response to treatment, the CI was referred to the MEB.  The NARSUM was accomplished 3 January 2007, 2 months before separation.  The CI reported he woke with back pain rated at 2-3/10.  His pain was aggravated by driving, lifting, and bending and was somewhat relieved with narcotic medication.  Physical examination of the back noted tenderness of the lumbar paraspinal muscles, absence of neurosensory or motor deficits, and normal tendon reflexes.  Range of motion (ROM) was not documented.  The examiner noted that the CI was unable to perform unlimited running, walking, biking, and swimming but was able to walk at own pace and distance.  

The VA Compensation and Pension (C&P) examination was conducted a month after separation.  The CI reported continuous back pain with weakness and stiffness.  His medications helped to relieve his symptoms.  Examination of the back recorded forward flexion to 90 degrees (90) and extension of 30 degrees (normal).  Pain on motion was absent.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the condition at 10%, coded analogously 5299-5237 for painful motion.  Likewise, the VA assigned a 10% rating coded 5237 for painful motion.  The ROM documented closest to separation recorded forward flexion to 90 degrees.  The higher rating of 20% is granted for evidence of forward flexion greater than 30 degrees but not greater than 60 degrees, or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour; not supported by the evidence.  The Board also noted code 5243 (intervertebral disc syndrome) was not applicable in this case since there was no evidence to support radicular symptoms produced functional limitation.  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.

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the PTSD condition was not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The psychiatry addendum to the MEB noted that the CI reported he was involved in the emergency care and transportation of severely injured civilian adults and children.  On one occasion, one of the children was wounded in a mortar attack and later died.  The CI also was experiencing marital difficulties which caused emotional distress.  He was treated by local combat stress control unit for 4 months in 2003-2004, and took medications which he discontinued after a few weeks.  At the time of the addendum, he reported symptoms of irritability, occasional nightmares, and other symptoms of posttraumatic stress disorder (PTSD).  The CI noted that he was currently involved in a supportive relationship with his girlfriend and enjoyed spending time with her and the children.  He was working and noted that he had good relationship with his employer.  The mental status examination was normal.  His mood was normal and affect was normal.  There was no evidence of impairment in cognition, thinking, or judgment.  There was no evidence of psychosis, anxiety or mood disorder.  A Global Assessment of Functioning score of 65 (mild) was documented and the examiner noted the CI did not meet DSM-IV diagnostic criteria for PTSD.  The examiner diagnosed PTSD, “resolving but still present,” noted there was mild impairment for civilian, social, and industrial adaptability, and opined that the PTSD was not medically disqualifying.  The PTSD condition was not profiled nor implicated in the commander’s statement as interference with duty performance.  The condition was not judged to fail retention standards.  There was no performance based evidence from the record that any mental health 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 fitness determination for the PTSD 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 PTSD 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 20140316, with attachments
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 XXXXXXXXXXXXXXXXXXXX, SSN XXXXXXXXX, AR20160006818 (PD201401723)

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