RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04368
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20021204

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, M1 Armor Crewman, medically separated for “chronic low back pain (LBP)” 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 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 - 20020903	VARD - 20030218	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5295	10%	Lumbar Myofascial Strain	5295	0%	20021107	
Left Knee	Not Unfitting	Left Knee, Retropatellar Pain Syndrome	5299-5257	10%		
Right Wrist		Right Wrist Extensor, Tenosynovitis	5099-5024	10%		
Partner Relationship Problem…		No VA Placement	
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 low back pain (LBP) condition began in July 2001 after he fell off of a tank onto his buttocks.  Despite duty restrictions, medications, chiropractic treatment, and physical therapy, his pain persisted and he was not able to return to full duty.  Repeat X-rays on 28 May 2002 were normal for the lumbar spine although possible shell fragments were noted in the left upper quadrant.  An orthopedic evaluation on 6 June 2002 noted that the X-rays were negative.  The range of motion (ROM) was full but painful. The neurological examination was normal.  The CI was thought to have chronic mechanical LBP. The MEB forwarded “chronic low back pain” for PEB adjudication.  

At the MEB examination (recorded on DD Form 2807 Report of Medical History and DD Form 2808 Report of Medical Examination) dated 6 June 2002, 6 months prior to separation, the CI reported a 1 year history of pain without significant improvement.  Flexion was reduced to 80 degrees (normal is 90), but the remainder of the ROM was normal.  The neurological examination was also normal.  A fitness for duty evaluation dated 23 July 2002 was done in the orthopedic clinic and showed a normal examination including the ROM.  It was noted that an MRI and a CT scan (neither is in evidence) were normal as were X-rays.  

At the MEB NARSUM examination on 13 August 2002, 4 months prior to separation, the CI reported increased pain with activity, but that he could walk at his own pace and distance without difficulty.  The DD 2808 examination was cited for physical findings.  

At the 7 November 2002 VA Compensation and Pension (C&P) evaluation performed, 1 month prior to separation, the CI reported recurrent, intermittent LBP.  The posture and gait were normal.  ROM exceeded VA normal values and pain with motion was not recorded.  The neurological examination and muscle tone were normal.  

At the time of separation, 4 December 2002, the interim spine rules were in effect and used by the PEB and VA to adjudicate the back condition.  Accordingly, these were also used by the Board in its rating recommendation rather than the current rules which took effect 26 September 2003.  The Board noted that this did not impact the rating recommendation.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic LBP condition 10%, coded 5295 (lumbosacral strain), citing pain with motion.  The VA rated the lumbar myofascial strain condition 0%, also coded 5295, based on the VA C&P examination, 1 month before separation, citing a normal examination and slight subjective symptoms.  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 LBP condition.  

Contended PEB Conditions:  Left Knee Retropatellar Pain Syndrome; Right Wrist Strain; Partner Relationship Problem and Occupational Problem.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement.  All were judged to meet retention standards.  There was no 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 chronic low back pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended left knee retropatellar pain syndrome, right wrist strain, partner relationship problem and occupational problem 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 20140707, 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 
, AR20160018435 (PD201404368)

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