RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02173
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070309

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Signal Support Systems Specialist, medically separated for “chronic low back pain,” rated 10%, with a disability rating of 10%.

CI CONTENTION:  She was only evaluated for the back condition and not for the other VA conditions.  Her 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- 20070109	VARD -20070801  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5243	10%	Lumbar Disk Disease Status Post Laminectomy And Diskectomy…	5243	10%	20070625	
Myofascial Pain Syndrome	Not Unfitting 
	Fibromyalgia 	5025	10%	20070625	
Anxiety Disorder and Adjustment Disorder with Depressed Mood		Anxiety Disorder	9400	10%	20070619	
Stress Urinary Incontinence		Stress Incontinence	7699-7623	10%	20070625	
Hallux Valgus		Right Hallux Valgus	5280	0%	20070625	
Recurrent Headaches		Migraine Headaches	8100	0%	20070625	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDTIONS   70%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent back surgery with discectomy and laminectomy in October 2005.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic low back pain with lumbar degenerative disc disease status post L4-L5 discectomy” for PEB adjudication.

The MEB NARSUM examination on 11 October 2006, 5 months prior to separation, noted complaints of constant low back pain which she rated pain as 5/10.  She also reported radiating pain posteriorly into the right thigh down to the knee level.  Her pain increased to 7/10 with prolonged standing or walking, with prolonged sitting, with bending or lifting, with climbing stairs, with significant physical exertion, and with impact activities.  Physical examination showed there was tenderness to palpation in the lower cervical, thoracic, and lumbar muscles and no muscle spasms.  There was no evidence of neuropathy, and motor and neurological examinations were normal.  There was positive lumbar pain with axial compression.  The examiner noted that range of motion (ROM) testing was performed by physical therapy (PT), documented forward flexion of 50 degrees (normal 90) and extension of 10 degrees (normal 30).  At the 25 June 2007 VA Compensation and Pension (C&P) evaluation, performed 3 months after separation, the CI reported she still had pain that was constant, moderate, sharp, dull, and throbbing with shooting pain to the right thigh.  Physical examination showed mild tenderness to palpation over the lower lumbar area.  ROM recorded forward flexion of 70 degrees and extension of 30 degrees with combined ROM of 195 degrees (normal 240).

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5243 (intervertebral disc syndrome), citing, limitation of motion.  The VA also rated the back condition 10% coded 5243, based on the VA C&P examination 3 months after separation, citing limitation of forward flexion.  The Board noted that the limitation of thoracolumbar motion recorded PT examination for the MEB NARSUM met the threshold for a 20% rating.  However, the VA examination was more proximate to separation, was more detailed and compliant with VASRD rating guidelines that supported a 10% rating.  Therefore the Board placed greater probative value on the VA C&P examination.  

The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI reported radiating pain.  The NARSUM examination revealed no objective findings of radiculopathy that would impact duty performance.  The presence of functional impairment with a direct impact on fitness is the key determinant in the Board’s decision to recommend any condition for rating as additionally unfitting.  While the CI may have suffered additional pain from the nerve involvement, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  Therefore the critical decision is whether or not there was a significant motor weakness which would impact military occupation-specific activities.  There was no evidence in this case that motor weakness existed to any degree that could be described as functionally impairing.  The Board therefore concluded that an additional disability rating was not justified.  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 condition.  

Contended PEB Conditions:  Myofascial Pain Syndrome, Anxiety Disorder, Stress Urinary Incontinence, Hallux Valgus, and Mild and Recurrent Headache.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are 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 myofascial pain syndrome, anxiety disorder, stress urinary incontinence, hallux valgus, mild and recurrent headache 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 20140513, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 AR20160013535 (PD201402173)

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