RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03913
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060419

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Human Resources Specialist, medically separated for “chronic non-radiating thoracolumbar back pain,” with a disability rating of 10%.

CI CONTENTION:  He should have received a higher rating from active duty.  The VA rated me at 60%.  The applicant’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 on 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 - 20060405	VARD - 20070523	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Non-Radiating Thoracolumbar Back Pain	5299-5237	10%	Mechanical Low Back Strain	5024	10%	20061204	
Asthma	Not Unfitting	Asthma	6602	30%	20061128	
Right Ankle Pain	Not Unfitting	Right Ankle Sprain	5271	NSC	20061204	
Migraine Headaches	Not Unfitting	Migraine Headaches	8100	30%	20061204	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:

Chronic Non-Radiating Thoracolumbar Back Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM) the CI’s low back pain (LBP) condition began in 1998 without a specific event or injury cited.  Despite conservative treatment to include local injections, his back pain continued.  He was given a L3/U1 profile and referred to a MEB.  The MEB forwarded chronic back pain to the PEB for adjudication.  At the MEB NARSUM examination in February 2006, 2 months prior to separation, the CI reported continued back pain.  The examination revealed a non-antalgic gait and tenderness about the low back.  There was full but painful range of motion (ROM) of the thoracolumbar spine.  Motor and sensory parameters were intact.  Muscle spasm and spinal contour were not cited.  

At the VA Compensation and Pension (C&P) examination in December 2006, performed 8 months after separation, the CI reported worsening LBP extending into his left leg associated with numbness the buttock, knee, foot and great toe.  The physical examination revealed a normal gait.  There was thoracic scoliosis and increased lumbar lordosis present without spasm and or tenderness.  Motor and sensory parameters were intact.  Thoracolumbar ROM was painful but normal excepting extension of 10 degrees (normal is 30).  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned the condition a 10% rating analogously coded 5299-5237 (lumbosacral strain), citing spinal tenderness.  The VA assigned a 10% rating coded 5024 (tenosynovitis) based on the VA C&P examination, citing painful motion.  The Board noted that neither the NARSUM nor VA examinations supported a 10% rating justified by limitation of flexion (greater than 60 degrees but not greater than 85).  The Board agreed both NARSUM and VA examinations support a 10% rating based on painful motion and or spinal tenderness.  Additionally, there was no muscle spasm or guarding to cause an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating 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 chronic non-radiating thoracolumbar back pain condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the asthma, migraine headaches, and right ankle conditions were not unfitting.  The conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.  All were reviewed and considered by the Board.  There was no performance based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance.  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’s fitness determination for the any of the contended conditions and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the chronic LBP condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended asthma, migraine headaches, and right ankle conditions, the Board unanimously recommends no change from the PEB’s 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 20140901, 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 (PD201403913)

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