RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00088
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20020915

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3, Indirect Fire Infantryman, medically separated for “chronic low back pain (LBP)” and “occult fracture, left cuboid,” rated 10% and 10% respectively, with a combined 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:  

USAPDA - 20020710	VARD - 20030508	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5295	10%	Chronic Low Back Pain	5295	20%	20030412	
Occult Fracture, Left Cuboid	5283	10%	…Left Foot Cuboid	5299-5284	0%	20030412	
Left Index Finger Stiffness	Not Unfitting	…Left Index Finger	5227	0%	20030412	
Decreased Visual Acuity Right Eye	Not Unfitting	No VA Placement	
Adjustment Disorder…	Not Unfitting	Adjustment Disorder…	9499-9435	NSC	20030412	
COMBINED RATING:  20%	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 had numerous episodes of non-incapacitating low back injuries during the period from 1997-2001.  Plain X-rays of the lumbar spine were reported as normal in December 2001 and an MRI performed in June 2002 revealed an L5-S1 bulging disc without neural compression.  His diagnosis remained as chronic LBP.  There was no surgical indication.  Despite conservative treatment, including extensive manipulations, 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.  

An orthopedic evaluation performed 9 days prior to the MEB NARSUM revealed normal forward flexion and extension of the thoracolumbar spine.  At the MEB NARSUM examination performed on 18 April 2002, 6 months prior to separation, the CI endorsed constant LBP extending into both posterior thighs which was aggravated by prolonged sitting, standing, or sleeping in the wrong position.  His spinal-focused physical examination (PE) revealed lumbar tenderness and decreased thoracolumbar range of motion (ROM) noting flexion to 75 degrees and a total combined ROM of 210 degrees (normal is 240).  There was no evidence of a palpable deformity or spasm of the lower spine.  

At the VA Compensation and Pension (C&P) evaluation performed on 12 April 2003, 7 months after separation, the CI reported daily LBP associated with local spasms.  His PE revealed spasms of the lateral lumbar spine as well as painful and decreased thoracolumbar ROM, noting forward flexion to 55 degrees.  Radicular symptoms were absent.  An Independent Medical Examination (IME) performed on 22 June 2003, 9 months after separation, indicated painful “mild to moderate” limitation in forward flexion of the lumbar spine and painful “moderate” limitation of extension.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the back condition at 10% coded 5295 (lumbosacral strain).  Utilizing the same code, the VA rated the back condition at 20% citing “…muscle spasms on forward bending and chronic daily pain”.  In accordance with DoDI 6040.44, the Board is required to recommend a rating IAW the VASRD in effect at the time of separation, which in this case, was the 2002 VASRD standards for the spine.  Although the case file indicates varying ROM limits of the thoracolumbar spine, all Board members agreed that a 10% rating was supported based upon the consistent findings of functional loss (VASRD §4.40) and or painful motion (§4.59) in the totality of clinical evaluations.  Therefore, 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 pain condition.

Left Foot (Cuboid).  According to STRs and the MEB NARSUM, the CI injured his left foot/ankle in a sports related incident in 2000.  Radiographic imaging revealed an occult fracture of the left cuboid (foot bone).  Podiatry did not recommend surgery and restriction of activities did not adequately rehabilitate the condition to meet the physical requirements of the CI’s specialty and the condition was referred for an MEB.  At the MEB NARSUM examination the CI endorsed the inability to run or march.  His foot-focused PE revealed tenderness over the outer aspect of the left foot.  There was no evidence of associated swelling, redness, or warmth.  A neurologic examination was normal.  At the VA C&P examination there was tenderness adjacent to the left ankle as well as painful motion.  The ankle and foot ROM, strength, and neurosensory status were normal and intact.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left foot condition at 10% coded 5283 (tarsal bone; malunion or non-union); whereas the VA rated 0% analogously coded under 5284 (foot injuries; other) citing the absence of any disabling effects.  Board members first agreed that the PEB’s code choice of 5283 was most appropriate to the CI’s pathologic condition.  Furthermore, all members agreed that the persistence of tenderness and or painful motion about the left foot/ankle did not rise above a descriptive level of moderate (10%) impairment.  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’s adjudication for the left foot condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the left index finger stiffness, decrease right eye visual acuity, and adjustment disorder with mixed anxiety and depressed mood were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement and none were judged to fail retention standards.  All were reviewed and considered by the Board.  Although the CI did receive mental health counselling and treatment, his originating issues were that of occupational and partner relational problems.  There was no performance based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance.  After due deliberation, 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 these contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:   In the matter of the low back condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the left foot condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended left index finger stiffness, decreased right eye visual acuity, and adjustment disorder with mixed anxiety and depressed mood 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 20150127, 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 
XXXXXXXXXXXXXXXXXX, AR20160018845 (PD201500088)

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