RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX		CASE:  PD-2015-00343
BRANCH OF SERVICE:  Army 		SEPARATION DATE:  20050913

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, Health Care Specialist, medically separated for chronic low back pain (LBP) and left leg pain, rated 10% and 0%, respectively, with a combined disability rating of 10%. 

CI CONTENTION:  The CI contended that he has numerous other conditions that should be reviewed.  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 determinati                                        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 - 20050523	VA - STR	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain…	5243	10%	Low Back Pain	5237	NSC	STR	
Left Leg Pain…	5099-5003	0%	Bilateral Tibial Stress Fractures	5299-5262	NSC	STR	
RATING:  10%	RATING:  -%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  Other than a remote history of a low back strain diagnosed in early 2001 (motor vehicle accident), the CI insidiously developed LBP and wasn’t evaluated until early 2005.  Radiographs revealed lumbosacral herniated discs with L-5 nerve compression.  Electro-diagnostic studies were non-diagnostic for a radiculopathy stemming from the lumbosacral spine.  The CI declined the consideration of spinal surgery.  Despite conservative treatment to include epidural injections, his back pain continued.  The CI was permanently profiled in April 2005 and referred to a Medical Evaluation Board (MEB).  At the MEB narrative summary (NARSUM) examination, the CI’s chief complaint was LBP and denied any radiculopathy.  The physical exam (PE) noted minimal and painful thoracolumbar range-of-motion (ROM) as well as tenderness about the lumbar spine.  As previously noted, there was no spinal focused VA examination performed near the time of separation.  

The PEB rated the back condition at 10% using VASRD code of 5243 (Intervertebral disc syndrome) whereas the VA noted the condition was not service-connected (NSC).   Board members first agreed that in light of non-compensable ROM measurements within 6 months of separation, the evidence of tenderness and or painful motion supported a VASRD impairment level no greater than 10% under the application of either §4.59 or §4.40.  The Board additionally considered if any degree of lower extremity radiculopathy warranted additional disability rating; but, members agreed that the requisite link of any neuropathy symptom with functional impairment was not in evidence.  Any pain component of a radiculopathy is subsumed under the general spine rating as specified in §4.71a.  Considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 10% for the LBP condition was appropriately recommended in this case.

Left Leg Pain Condition.  The CI was diagnosed with a left lower leg tibia stress fracture in November 2004.  Despite conservative treatment, he still required the use of crutches as of mid-January 2005.  The NARSUM performed in March 2005 noted that the CI had left leg pain and was ambulating with a cane.  His lower extremity focused PE revealed tenderness along the left tibia.  The diagnosis was noted as “left non-healed tibia stress fracture.”  Additionally listed were radiographic data that included the following:
	
“Radiographs of bilateral lower extremities reveal no evidence of osseous or soft tissue abnormalities.  MRI [magnetic resonance image] of bilateral lower extremities reveals focal stress fracture at the distal third of the left tibia, extending to the posterolateral cortex.”

The PEB rated the left leg condition at 0% citing that current radiographs were within normal limits.  Board members first agreed that the NARSUM’s radiographic comments clearly did not indicate such healing as indicated by the PEB.  Additionally, Board members considered that the reported radiographic data (although not dated) was simply transcribed from the dated magnetic resonance imaging (MRI) conducted (4 months prior) in November 2004 as previously mentioned above.  Bottom-line, the Board remained uncertain if the previously diagnosed left leg stress fracture was healed or not.  Members deliberated and agreed that the evidence of needing and using a cane for ambulation at the MEB examination did support an impairment rating greater than 0%.  Members concluded that an analogous rating under the 5022 code (periostitis) which defaults to the 5003 code (arthritis, degenerative) based on residual tenderness without loss of joint motion was appropriate in this case and therefore, provided maximum benefit to the CI.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the left leg condition. 

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 leg condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5022 IAW VASRD §4.71a.  There were no other conditions within the Boards scope of review for consideration.  The Board, therefore, recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

CONDITION	VASRD CODE	RATING	
Chronic Low Back Pain 	5243	10%	
Left Tibial Stress fracture	5099-5022 	10% 	
COMBINED RATING	20% 	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150527, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXX, AR20160006110 (PD201500343)

1. 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,
accept the Board's recommendation to modify the individual's disability rating to 20%
without re-characterization of the individual's separation. This decision is final.

2. I direct that all the Department of the Army records of the individual concerned be
corrected accordingly no later than 120 days from the date of this memorandum.

3. I request that a copy of the corrections and any related correspondence be provided
to the individual concerned, counsel (if any), any Members of Congress who have
shown interest, and to the Army Review Boards Agency with a copy of this
memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:
CF:
( ) DoD PDBR
( ) OVA