RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01967
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060302

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Helicopter Repairer, medically separated for “low back pain,” with a disability rating of 0%.

CI CONTENTION:  His condition continues to worsen and negatively impacts his daily activities, and he asks for his hands to be considered.  His 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 - 20060119	VARD – 20060210	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain, with Multilevel Spondylosis	5299-5242	0%	Lumbar Degenerative Disc Disease	5243	0%	20051001	
			Radiculopathy, Right Leg	5299-5252	NSC	20051001	
Hand and Wrist Pain	Not Unfitting	Arthralgia, Right Wrist (Major)	8515-5215	0%	20051001	
		Arthralgia, Left Wrist 	8515-5215	0%	20051001	
		Right Hand Condition (Major)	5299-5220	NSC	20051001	
		Left Hand Condition	5299-5220	NSC	20051001	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Low Back Pain (LBP).  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in 2002 after a parachute landing fall.  Magnetic resonance imaging in August 2005 revealed lumbar spondylosis, lumbar degenerative disk disease (DDD) and disk bulges.  Orthopedic evaluation determined that his symptoms would not benefit from surgery.  He was treated with numerous therapeutic modalities.  In spite of all treatment efforts, the LBP did not improve adequately to meet the physical requirements of the CI’s military specialty and he was referred for an MEB.  The MEB forwarded “lumbar degenerative disk disease and multilevel spondylosis” for PEB adjudication.  The range of motion (ROM) examinations in evidence which the Board weighed in arriving at its recommendation, are summarized in the chart below. 
 
Thoracolumbar ROM
(Degrees)	VA ~3 Mos. Pre-Sep	PT MEB ~2 Mos. Pre-Sep	
Flexion (90 Normal)	90	75	
Combined (240)	240	160	
Comments	No pain with motion	Pain with motion	
§4.71a Rating	0%	10%	

The MEB NARSUM examination on 6 October 2005, 5 months prior to separation, noted complaints of daily pain which was made worse with prolonged immobilization, sitting, standing or lying.  There were intermittent pain flares approximately once per year.  On examination, lower extremity strength, sensation and reflexes were normal.  Provocative maneuvers for signs of radiculopathy or radiating pain due to spinal nerve root involvement were negative.  Thoracolumbar ROM was conducted by physical therapy (PT) on 29 December 2005, and is summarized in the chart above.

At the VA Compensation and Pension (C&P) examination on 1 December 2005, performed 3 months before separation, the CI reported pain that was aggravated by prolonged standing, prolonged sitting, running and walking.  Physical exam showed no swelling, joint effusion or tenderness.  The examiner noted that repetitive movement did not worsen the pain, or result in limitation due to weakness or fatigability.  

The Board directed attention to its rating recommendation based on the evidence.  The PEB chose VASRD code 5299-5242 (analogous to degenerative arthritis of the spine), and rated the condition 0%, citing limitation of motion due to pain.  The VA also rated the back condition 0%, but used VASRD code 5243 (intervertebral disc syndrome).  The Board determined that the December 2005 MEB physical therapy examination was just 9 weeks before separation, and therefore had significant probative value.  At that exam, there was 75 degrees of forward flexion, and the combined thoracolumbar ROM was 160 degrees.  IAW VASRD §4.71a, a disability rating of 10% is warranted when thoracolumbar forward flexion is greater than 60 degrees but not greater than 85 degrees.  A 10% rating is also warranted when combined thoracolumbar ROM is greater than 120 degrees but not greater than 235 degrees.  Therefore, the Board determined that a 10% rating was appropriate in this case. 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 insufficient evidence of incapacitating episodes, thus a higher rating could not be justified on this basis.  

The Board also considered the matter of radiculopathy.  After review of all the information in the record, there was insufficient evidence of a clinically significant radiculopathy that interfered with performance of military duties.  Therefore, the Board concluded that there was no unfitting radiculopathy present at the time of separation.  Considering all of the evidence and mindful of VASRD §4.3 (Reasonable doubt), the Board unanimously recommended a 10% disability rating for the back pain condition, IAW VASRD §4.71a.  

Contended PEB Conditions.  The PEB adjudicated hand and wrist pain as not unfitting.  The Board’s main charge with regard to this condition is to assess the fairness of the PEB’s adjudication.  The Board’s threshold for countering a fitness determination is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The hand and wrist pain condition was not profiled or implicated in the commander’s statement, nor was it judged to fail retention standards.  There was no performance-based evidence from the record that the hand and wrist pain significantly interfered with satisfactory duty performance.  After due deliberation, and in consideration of the preponderance of the evidence, the Board found insufficient cause to recommend a change in the PEB fitness determination for the hand and wrist pain.  Therefore, no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the low back pain condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5242, IAW VASRD §4.71a.  In the matter of the hand and wrist pain, 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.  Therefore, the Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Subjective Low Back Pain, with Multilevel Spondylosis	5299-5242	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140424, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20160008561, XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board's recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records. I regret that the facts of the case did not provide you with the outcome you may have desired.

This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

A copy of this decision has also been provided to the Department of Veterans Affairs and to the counsel you listed on your application.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Deputy Assistant Secretary of the Army

Enclosure