RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX		CASE:  PD-2014-3048
BRANCH OF SERVICE:  Army		SEPARATION DATE:  20071217

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Guard, E4, Armor Crewman, medically separated for “lumbosacral strain” with a disability rating of 10%.

CI CONTENTION:  The CI requested that the Board consider all conditions.  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 - 20070822	VARD - 20080806	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbosacral Strain	5237	10%	Lumbosacral Strain	5237	10%	STR	
Depressive Disorder	Not Unfitting	Post-Traumatic Stress Disorder	Not Service Connected	
COMBINED RATING:  10%	COMBINED RATING FOR ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Lumbosacral Strain.  The service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM) documented a back injury sustained in June 2004 from a vehicular accident during a deployment to Iraq.  The CI was treated in theater and completed the deployment.  He reported continued pain after redeployment with some proximal radiation, but no subjective weakness or sensory complaints.  Imaging demonstrated multilevel degenerative disc disease with no significant nerve involvement.  Multiple neurological examinations were normal, and surgery was not recommended.  The symptoms failed to respond satisfactorily to conservative treatment and the MEB forwarded “lumbago (degenerative disk disease)” for PEB adjudication.  There was no outpatient STR evidence for more significant range of motion (ROM) limitation than the measurements given below.  There was no suggestion of abnormal spinal contour, and a normal gait was recorded by multiple examiners.  There were no STR entries contrary to any of these ratable features or documentation of incapacitating episodes.
  
The NARSUM was conducted 30 March 2007 (8 months prior to separation) and documented continued pain (with no mention of radiation or neurological symptoms) which rendered the CI unable to perform heavy lifting or carrying, run, or jump.  The NARSUM physical examination recorded a normal gait, tenderness without spasm, “decreased [ROM] in extension and lateral bending,” and normal neurological findings (5/5 strength).  Formal ROM measurements for the MEB by physical therapy were conducted on the same day as the NARSUM and documented flexion to 70 degrees (normal 90) and combined ROM of 190 degrees (normal 240).  A physical medicine consult was obtained 2 days preceding the NARSUM, and the examiner noted bilateral leg radiation without sensory symptoms.  The physical examination recorded a normal gait and normal neurological findings; and, ROM measurements were flexion to 80 degrees, extension 10 degrees (normal 30), and normal bilateral flexion.  The CI failed to report for a scheduled VA examination, and there was no temporally probative VA post-separation evidence.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating under code 5257 (lumbar strain) was consistent with VASRD §4.71a criteria for the service ROM evidence and other ratable findings, and the VA conferred the same rating under the same code based on service evidence.  There was no ROM evidence supporting a rating higher than 10%, no evidence for abnormal gait or contour to support a 20% rating, no evidence for ratable peripheral nerve impairment which would provide for additional rating, and no documentation of incapacitating episodes which would provide for a higher rating under that formula.  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 of the lumbosacral strain.

Contended Mental Health (MH).  There were no documented MH issues during the Iraq deployment.  The post-deployment health reassessment documented some nightmares and avoidance, but no other features of posttraumatic stress disorder (PTSD), and no MH referral was requested.  The first MH complaint in evidence was in August 2006 (19 months after redeployment) when the CI complained to his primary care provider of depression and sleep disturbance.  He was prescribed an anti-depressant (Sertraline); and, a psychiatric addendum of 26 March 2007 (just prior to the NARSUM) documented a favorable response to that treatment, noting that “his mood has been fine ... although recently annoyed” and a recent recurrence of sleep disturbance.  No other significant psychiatric symptoms were documented, the mental status examination was normal except for an “irritated” mood, and the Global Assessment of Functioning assignment was 68 (mild range of impairment).  The MEB psychiatrist provided the Axis I diagnosis of depression forwarded by the MEB, opining that the condition was stable, that it met retention standards, and that it “does not require any permanent profile restrictions.”  The commander’s performance statement detailed high functioning within the physical limitations imposed by the back condition.  As above, there was no temporally probative post-separation evidence; and, the VA denied service connection for a claim of PTSD citing the absence of any STR evidence for diagnosis or treatment of that condition.  A diagnosis of PTSD with a rating of 70% was conferred by the VA effective 8 August 2011 (~4 years after separation).

The Board’s main charge is to assess the fairness of the PEB’s determination that the MH condition was not unfitting.  The Board’s threshold for countering service fitness determinations 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.  Although it was clear that the CI manifested some MH symptoms at separation, there was no performance-based evidence that countered the MEB psychiatric opinion that that there was no MH impairment that would have precluded further service.  The S1 profile, the commander’s opinion, and the lack of any evidence from the STR suggesting significant functional impairment from MH symptoms were additional compelling arguments supporting a conclusion that the MH condition was not unfitting in this case.  After due deliberation in consideration of the preponderance of the evidence, members agreed that there was insufficient cause to recommend a change in the PEB fitness determination for the MH condition.

BOARD FINDINGS:  In the matter of the lumbosacral strain and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended mental health 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 20140620, 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 XXXXXXXXXXXXXXXXXXXX, AR20160007955 (PD201403048)

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