RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03854
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080227

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Linguist/Interrogator, medically separated for “chronic low back pain [LBP]” and “left trochanteric bursitis,” rated 10% and 10%, respectively, with a combined disability rating of 20%.

CI CONTENTION:  The CI indicates the “initial rating was inaccurate.”  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 – 20071106	VARD – 20090713	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Myofascial Pain Syndrome (Claimed as Neck…Back…Left Hip…)	5099-5025	40%	20090223	
Left Trochanteric Bursitis	5019	10%					
Left Ankle Pain	Not Unfitting 	Left Ankle Ganglion Cyst	5271	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic LBP.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s LBP began in October 2004 without specific injury or trauma, and was exacerbated by motor vehicle accidents (MVA’s) in January and December 2005, which were followed by a series of falls.  Radiographic imaging studies performed in February 2005 and again in September 2006 revealed no vertebral or disc producing abnormalities.  Her diagnosis remained as lumbago (generalized LBP).  There was no surgical indication.  Despite conservative treatment, the LBP condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “LBP, refractory to conservative treatment” for PEB adjudication.  A Primary Care encounter dated 5 July 2007 (8 months prior to separation) indicated no abnormalities of the thoracic and lumbosacral spine.  A clinical encounter dated 2 August 2007 (7 months prior to separation) indicated “FROM” under a back examination.  At the MEB NARSUM examination performed on 6 September 2007 (6 months prior to separation), the CI endorsed constant LBP with stiffness and spasms, aggravated by lifting, twisting, jumping, running, physical exercise maneuvers, and prolonged sitting or standing.  Her PE revealed spinal tenderness.  Neurologic examination was normal and provocative tests for nerve root impingement were negative for radiculopathy.  Her pain was assessed as ‘moderate’ and ‘constant’.  Her spinal range of motion (ROM) was performed by physical therapy (PT) on 30 May 2007 (3 months earlier; 9 months prior to separation) noting tenderness, painful motion, and minimal decreased ROM as measured partially with an inclinometer.  At the VA Compensation and Pension (C&P) evaluation performed on 23 February 2009 (12 months after separation), the CI reported back pain with spasms, fatigability, and lack of endurance that caused her difficulty with work and activities of daily living.  Her pain was rated at 6-7/10 with weekly flare-ups to 10/10.  The examiner indicated the CI “uses a cane.”  Her PE revealed an abnormal gait favoring the right side.  Decreased sensation was noted in the entire left and lower right leg, in a non-physiologic distribution.  Spinal ROM was normal.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP condition 10% coded 5237 (lumbosacral strain), citing full ROM with tenderness.  The VA rated the low back condition in combination with neck and hip pain at 40% coded 5099-5025 (analogous to fibromyalgia), based on the VA C&P examination 12 months after separation, with no cited rationale for the basis of the low back rating.  Although there was insufficient limitation of motion to support a minimum rating, all Board members agreed that a 10% rating was justified for the presence of painful motion and or tenderness reported on examinations proximate to separation.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% 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’s adjudication for the chronic LBP condition.  

Left Trochanteric Bursitis.  According to the STR, the CI’s left hip pain condition began after involvement in a MVA in 2005.  Imaging studies of the left hip were “unremarkable”.  Diagnosed with “bursitis”, non-surgical treatment to include pain management and local injections did not adequately rehabilitated her to meet the physical requirements of military service and she was referred for an MEB.  The MEB forwarded “left hip pain, refractory to conservative treatment” for PEB adjudication.  At the MEB NARSUM examination, the CI endorsed left hip pain aggravated by lifting, walking, jumping, driving a stick shift, and prolonged standing.  Her detailed PE with ROM was conducted on 9 July 2007 (8 months prior to separation) and revealed near normal but painful motion of the left hip.  At the VA C&P examination, the CI revealed left thigh extension of zero degrees as well as painful motion in other directional movements.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left hip condition 10% coded 5019 (bursitis), citing painful motion.  The VA rated the condition in combination as previously described above.  Board members agreed that evidence of painful motion was sufficient at pre-separation to justify the PEB’s 10% rating under VASRD §4.59.  Additionally, members acknowledged the limited hip extension of zero degrees as noted on the VA exam and its sole 10% rating would not support a greater rating than the PEB’s current 10%.  Therefore, after due deliberation, considering all of the evidence and mindful of VASRD §4.3, the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left hip condition.  

Contended PEB Condition.  Left ankle pain.  The Board’s main charge is to assess the fairness of the PEB’s determination that left ankle pain was not unfitting. The left ankle pain was profiled, but generally in combination with other conditions.   The only profile specific for the left ankle condition was a permanent L2 code, which is a profile that is acceptable for the CI’s MOS.  The ankle was not specifically implicated in the commander’s statement.  The NARSUM and MEB indicated the left ankle condition failed retention standards, but as the Formal PEB indicated, this condition was present for almost 4 years prior to separation, and did not negatively impact the performance of her duties during that time.  In the 2 years prior to separation, there were only fvie medical appointments that addressed the left ankle, and three of these were associated with the MEB process (measurements, examinations, etc).  There was no performance based evidence from the record that the left ankle 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 left ankle pain, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the chronic LBP and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the left trochanteric bursitis and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended left ankle pain, 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 20140816, 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

07 DEC 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
AR20160018212 (PD201403854)

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