RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03204
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050208

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, UH-60 Helicopter Repairer, medically separated for “chronic low back pain,” with a disability rating of 10%.

CI CONTENTION:  “Please 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 – 20040901	VARD – 20051026/20060209*	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5237	10%	Lumbar Strain with Chronic Pain	5237	20%	20050808	
Decreased Visual Acuity, Left Eye	Not Unfitting	Decreased Visual Acuity, Left Eye	6099-6079	NSC	20050711	
Pes Planus, bilateral		Bilateral Pes Planus	5276	NSC*	20051122	
Ganglion Cyst, Left Hand		Ganglion Cyst, Left Wrist	7819	10%*	20051122	
Sensorineural Hearing Loss, Right Ear		Hearing Loss, Right Ear	6100	NSC*	20051024	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic low back condition began in May 2002 while participating in a weight lifting contest.  Diagnostic imaging (X-ray) studies 7 June 2002 showed a normal lumbar spine.  He reinjured his back when he was involved in a motor vehicle accident in September 2002.  Diagnostic imaging (MRI) studies 22 October 2002 showed no significant central canal stenosis (narrowing), neural foraminal (nerve root opening) narrowing, or definite disc protrusion.  The discs were normal in appearance with the exception of mild broad-based bulging at the levels of L3-4, L4-5, and LS-S1.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “lumbago,” for PEB adjudication.  

Thoracolumbar range of motion (ROM) measurements performed by physical therapy (PT) on 7 July 2004 showed flexion of 55 degrees (normal 90) and combined ROM of 190 degrees (normal 240) with painful motion and a normal gait.  

During the 18 August 2004 MEB examination, 6 months prior to separation, the CI reported non-radiating bilateral lower back pain.  The pain was not present at rest but was aggravated by prolonged standing, ruck marching, lifting more than 15 pounds, and running and jumping activities.  The pain did not affect his daily activities but affected his ability to perform physical training and the physical demands of his military specialty.  He was not taking any medications for the pain.  Physical examination showed normal gait, strength, deep tendon reflexes (DTRs), and sensation.  There was lumbar tenderness and examination maneuvers for radicular (nerve root irritation or injury) signs were negative.  

At the 8 August 2005 VA Compensation and Pension (C&P) examination, performed 6 months after separation, the CI reported lumbar strain and constant low back pain described as severe.  He had stiffness described as severe and mild lumbar weakness with no spasm.  He used stretching exercises to treat the pain.  Physical examination showed a normal spinal contour and no spasm, guarding, or tenderness.  There was an abnormal gait.  Strength, DTRs, and sensation were normal and examination maneuvers for radicular signs were negative.  Thoracolumbar ROM measurements showed flexion of 60 degrees (normal 90) and combined ROM of 155 degrees (normal 240) with painful motion and an antalgic gait.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10% coded 5299-5237 (lumbar spine strain), citing no neurologic abnormality, thoracolumbar ROM limited by pain, and localized tenderness.  The VA rated the low back condition 20% coded 5237 (lumbar spine strain), based on the VA C&P examination 6 months after separation, citing limitation of flexion to 60 degrees with pain.  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) reported on the MEB (PT) and the VA examination.  After due deliberation, and considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the chronic low back condition, coded 5237.   

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that decreased visual acuity, left eye, pes planus, bilateral, ganglion cyst, left hand, and sensorineural hearing loss, right ear were not unfitting.  The  decreased visual acuity, left eye, pes planus, bilateral, ganglion cyst, left hand, and sensorineural hearing loss, right ear were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.  There was no performance-based evidence from the record that the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, and in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the low back condition, the Board unanimously recommends a disability rating of 20%, coded 5237 IAW VASRD §4.71a.  In the matter of the contended decreased visual acuity, left eye, pes planus, bilateral, ganglion cyst, left hand, and sensorineural hearing loss, right ear 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 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	
Chronic Low Back Pain	5237	20%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140430, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20160011314, XXXXXXXXXXXXXXXXXXX

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, XXXXXXXXXXXXXXXXXXX.