RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-01853
BRANCH OF SERVICE:  Army	BOARD DATE:  20141217
SEPARATION DATE:  20071009

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Health Care Specialist) medically separated for a back condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was issued a permanent L3/S2 profile and underwent a Medical Evaluation Board (MEB).  The back condition, characterized as “non-radicular lower back pain with mild degenerative changes at L5-S1” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded two other conditions (adjustment disorder and attention deficit hyperactivity disorder [ADHD]) for PEB adjudication.  The Informal PEB adjudicated “lumbar degenerative disc disease” as unfitting, rated 10%.  The two mental health (MH) conditions were found to be conditions not constituting a physical disability.  The CI made no appeals at that time and was medically separated.

CI’s CONTENTION:  “Please consider all conditions.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the 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/Naval 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 IPEB – Dated 20070914	VA – 3 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar Degenerative Disc Disease (DDD)	5299-5242	10%	Low Back Strain, with Degenerative Changes 	5242	0%	20071207	
Adjustment Disorder	Not Constituting a Physical Disability	No VA Entry	
Attention Deficit Hyperactivity Disorder	Not Constituting a Physical Disability	No VA Entry	
Other x 0 (Not In Scope)	Other x 0	
Combined:  10%	Combined:  0%	
Derived from VA Rating Decision (VARD) dated 20080111 (most proximate to date of separation [DOS])
ANALYSIS SUMMARY:

Back Condition.  This CI started having low back pain after doing a fireman’s carry during a training event.  X-rays showed mild lumbar scoliosis, with disc degeneration at L5-S1.  Magnetic resonance imaging revealed some foraminal narrowing, with minimal central canal stenosis.  The CI was treated with physical therapy and pain medications.  However, the back pain persisted and MEB was initiated.  The MEB narrative summary was dictated on 20 June 2007.  At that exam, he was in no acute distress and gait was non-antalgic. He was able to walk on tip-toes and heels.  Physical examination of the lower back revealed diffuse tenderness of the paraspinal muscles.  Spinal curvature was normal.  Range-of-motion (ROM) was measured and is summarized in the chart below.

Three months after separation, on 7 December 2007, the CI had a VA Compensation and Pension (C&P) exam.  He was walking without a limp and had excellent posture.  He moved from chair to the examining table without any difficulty.  Straight leg raise was normal bilaterally.  Thoracolumbar ROM was normal.  The examiner’s diagnosis was, “Severe low back strain, with full healing and no functional impairment.”  The ROM evaluations, which the Board weighed in arriving at its rating recommendation, are summarized in the chart below.

Thoracolumbar ROM
(Degrees)	MEB ~ 3 mos. Pre-Sep
(20070620)	VA C&P ~ 3 mos. Post-Sep
(20071207)	
Flexion (90 Normal)	90	90	
Combined (240)	175	240	
§4.71a Rating	10%	0%	

The Board reviewed the data from the back exams noted above.  It was clear that the CI’s back condition improved during the period from June 2007 to December 2007.  His thoracolumbar combined ROM changed from 175 degrees to 240 degrees.  The Board could not find any clinical data from the actual date of separation (DOS).  The MEB exam was 3 months prior to the DOS and the C&P exam was 3 months after DOS.  The Board found it reasonable to assume that, on the DOS, thoracolumbar combined ROM was greater than 120 degrees but not greater than 235 degrees.  IAW VASRD §4.71a, a 10% disability rating is warranted when thoracolumbar combined ROM is greater than 120 degrees but not greater than 235 degrees.  Therefore, the Board determined that a rating of 10% was appropriate.  The Board tried to find a path to a higher rating for the back condition.  However, there was insufficient evidence of a significantly disabling back condition that would justify a higher rating.

The Board also considered the matter of peripheral neuropathy.  After reviewing all the information in the record, there was insufficient evidence of a clinically significant neuropathy that interfered with performance of military duties.  Therefore, the Board concluded that there was no unfitting radiculopathy present at the time of separation.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication for the back pain condition.

Mental health (MH) Conditions.  In May 2007, the CI self-referred to the MH clinic because he “was jumping at his own shadow and was afraid he’d commit suicide.”  He was diagnosed with anxiety, and was started on medication.  On 2 July 2007, he received a comprehensive psychiatric evaluation.  On mental status exam; he was alert, cooperative and respectful.  Speech was logical and goal-directed.  His mood was moderately depressed and there were no indications of psychotic processes.  Insight and judgment were fair.  There was a history of previous suicidal ideation and homicidal ideation, but none actively at that time.  Although the CI had a history of suicidal and homicidal ideation, there was no report of suicidal behaviors or threats of homicide; he was neither treated in the emergency room nor hospitalized for suicidal ideations.  The Axis I diagnosis was: adjustment disorder, acute, with mixed anxiety and depression, medically acceptable.  For “Premorbid personality predisposition,” the examiner wrote: Mild – history consistent with undiagnosed ADHD.  On 31 July 2007, the CI had a neuropsychological evaluation.  The results were congruent with the 2 July 2007 psychiatric exam.
As noted above, the two MH conditions (adjustment disorder and ADHD) were adjudicated by the PEB as not constituting a physical disability.  The Board considered the appropriateness of the adjudication of the MH conditions, as not constituting a physical disability.  The Board affirmed that the Army PEB was correct in that assertion, IAW the DoDI 1332.38 which was in effect at that time.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board could not find sufficient cause to justify a change in the PEB adjudication of the MH conditions.  The Board concluded therefore that the MH conditions could not be recommended for disability rating.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication. The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the LBP condition, and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the adjustment disorder and ADHD conditions, the Board unanimously recommends no change from the PEB determination.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  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 201401853, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

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 XXXXXXXXXXXXXXX, AR20150013655 (PD201401853)

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:

Encl						     XXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA