RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03051
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080708

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an  E4, Wheeled Vehicle Mechanic, medically separated for “disc disease at L5-S1 with annular tear without neurologic deficits” with a disability rating of 20%.  

CI CONTENTION:  He was not evaluated or rated for his bilateral plantar fasciitis or tinea pedis, tinnitus, PTSD, hearing loss, sleep apnea, acid reflux, or gastroesophageal reflux disease.  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 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 - 20080506	VARD - 20080804	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Disc Disease L5-S1	5299-5242	20%	Degenerative Disc Disease with Annular Tear, Thoracolumbar Spine	5242	20%	20080503	
Anxiety	Not Unfitting	PTSD	9411	30%	20080422	
Bilateral Foot Pain	Not Unfitting	Plantar Fasciitis, Right	5299-5284	10%	20080503	
		Plantar Fasciitis, Left	5299-5284	10%	20080503	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Disc Disease L5-S1 … Without Neurologic Deficits.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in December 2005 after heavy lifting.  X-rays were negative.  Physical therapy and medication did not improve the condition and diagnostic imaging (MRI) in March 2007 showed disk disease at L5-S1 with an annular tear.  Evaluation by neurosurgery recommended non-surgical treatment.  Electrodiagnostic testing revealed no radiculopathy.  Despite treatment, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  The MEB forwarded “persistent lumbago” for PEB adjudication.  

The MEB NARSUM examination on 2 April 2008, 3 months prior to separation, noted complaints of low back pain with daily flare-us with activity.  Physical examination showed a normal gait.  The CI could heel walk and toe walk and motor, sensory and reflex examinations of the back and lower extremities was normal.  There was a normal spinal contour and no muscle spasm or radicular signs.  Thoracolumbar range of motion (ROM) was forward flexion of 60 degrees (normal 90) and combined 210 degrees (normal 240).  

At the 3 May 2008 VA Compensation and Pension (C&P) evaluation, performed 2 months before separation, the CI reported low back pain with stiffness, weakness, and numbness.  Pain was constant 7/10 and traveled to the legs.  He had difficulty with prolonged sitting, standing or carrying over 20 pounds.  He had no episodes of incapacitation.  X-rays showed minimal diffuse thoracic spondylosis.  Physical examination showed normal gait and posture.  There was tenderness without spasms.  Provocative testing for radicular symptoms was negative.  Neurologic examination was normal.  ROM was painful with forward flexion of 35 degrees (normal 90) and combined 100 degrees (normal 240).  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 20%, coded 5299-5242 (Degenerative arthritis of the spine), citing forward flexion to 60 degrees.  The VA also rated the back condition 20% coded 5242, based on the VA C&P examination 2 months before separation, citing range of motion criteria.  

The Board agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees) on all examinations and/or combined ROM not greater than 120 degrees reported on the VA examination.  The Board concluded there was no evidence to support a rating higher than the rating adjudicated by the PEB.  

There was no evidence of intervertebral disc syndrome (IVDS) which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula (for IVDS).  There was no associated radiculopathy for separate peripheral nerve rating.  While the CI may have experienced radiating pain from the back condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  There was no objective evidence of a radiculopathy with functional impairment (such as weakness) that directly impacted fitness for duty.  The Board therefore concluded that an additional disability rating was not justified on this basis.  

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:  Anxiety and Bilateral Foot Pain.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  Only the right plantar fasciitis was profiled.  The commander’s statement implicated mental health symptoms stating “Ability to maintain focus, attention to detail and communication skills are also affected; (CI) is not able to respond to changes in his routine”  Both conditions were judged to be medically acceptable.  The NARSUM indicated that other condition considered to be medically acceptable were anxiety for which the CI was evaluated and the psychiatrist felt that the neuropsychological testing did not confirm the presence of any cognitive deficits and that his psychiatric condition was medically acceptable as well as complaints of intermittent bilateral foot pam, which has required no ongoing treatment and is felt to be medically acceptable.  

There was insufficient 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 disc disease L5-S1 (back) condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended anxiety and bilateral foot pain 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 20140624, 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 
XXXXXXXXXXXXXXXXXX, AR20160017154 (PD201403051)

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