RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03594
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20080215

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Healthcare Specialist, medically separated for “chronic non-radicular back pain” with a disability rating of 20%.

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 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 - 20090317	VARD - 20080425	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Non-Radicular Back Pain	5237	20%	Degenerative Disc Disease …	5242	10%	20080211	
Anxiety Disorder	Not Unfitting 	PTSD w Depression	9411	70%	20080315	
RATING:  20%	RATING:  70%	

ANALYSIS SUMMARY:

Chronic Non-Radicular Back Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in June 2005 after heavy lifting which was aggravated in May 2006 after jumping from a truck.  Diagnostic imaging revealed lumbosacral degeneration and disc herniation with nerve-exiting encroachment.  There was no surgical indication, and conservative treatment to include medications, physical therapy, manipulations, and epidural steroid injections did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded non-radicular lumbar back pain for PEB adjudication.
During the MEB NARSUM examination on 17 September 2007 (5 months prior to separation), the CI reported continued low back pain aggravated by prolonged sitting and or any degree of increased activities.  He endorsed the inability to ruck, road march, wear flak vest, or carry gear.  Physical examination revealed tenderness and spasms about the thoracolumbar spine.  Range of motion (ROM), measured 1 month previously, revealed decreased flexion at 65 degrees (normal 90) and extension of 15 degrees (normal 30).

At the VA Compensation and Pension (C&P) examination (1 week prior to separation), the CI reported continued low back pain.  Physical examination revealed improved, but painful motion of the lumbar spine.  Flexion was measured at 70 degrees and extension 20 degrees.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 20%, coded 5237 (lumbosacral strain) citing painful motion.  The VA rated the back condition 10%, coded 5242 (degenerative arthritis of the spine) based on the C&P examination citing limited motion.  The Board agreed that based on the totality of the record, the STR and VA ROM examinations were indicative of the CI’s back condition at separation; and did not reach a 20% rating based on limitation of motion.  The Board found no evidence of intervertebral disc syndrome with incapacitating episodes which would provide for a rating higher than 20% under that formula or evidence of ratable peripheral nerve impairment which would provide for additional rating.  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 Condition:  Anxiety Disorder.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The condition was not profiled or implicated in the commander’s statement and was not judged to fail retention standards.  The condition was reviewed and considered by the Board.  Although the CI originally sought mental health counseling while deployed as well as psychiatry evaluation when he re-deployed on 25 October 2007 (4 months prior to separation), the STR did not reveal performance based evidence that the CI’s anxiety disorder significantly interfered with satisfactory duty performance.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the chronic non-radicular back pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended anxiety disorder condition, the Board unanimously agrees that it cannot recommend it for additional disability rating.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140719, 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

29 NOV 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160017686 (PD201403594)

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.

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA