RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02241
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20081231

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty W2, Network Management Technician, medically separated for “chronic low back pain,” with a disability rating of 20%.   

CI CONTENTION:  Additional unfitting conditions were not considered.  The complete submission is at Exhibit A.

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20080904	VARD - 20090325	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5243	20%	Thoracolumbar Spine Degenerative Disc Disease with Strain and Herniated Disc	5243	10%	20081110	
Bilateral Posterior Tibial Tendon Dysfunction	Not Unfitting	Left Shin Splints	5262	0%		
		Right Shin Splints	5262	0%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Chronic Low Back Pain.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back condition began in January 2005 after attempting to dunk a basketball.  An MRI showed a herniated disk L4-L5 and L5-S1 with evidence of nerve root involvement.

During the June 2008 MEB examination (recorded on DD Forms 2807 and 2808) 6 months prior to separation, the CI reported mid-back pain with numbness tingling and weakness in the right leg.  Physical examination showed the ability to heel and toe walk.  There was not muscle spasm but spinal tenderness was present.  Lower extremity muscle strength was normal except for mild decrease in strength of the right great toe.  Thoracolumbar range of motion (ROM) was decreased (measurements not cited); painful motion was not addressed.

The 6 August 2008 MEB NARSUM examination, 4 months prior to separation, noted complaints of chronic low back pain radiating down to the buttocks with tingling and numbness in the right leg.  Physical examination showed no muscle spasms or scoliosis, but there was spinal tenderness.   Lower extremity muscle strength was normal except the right big toe, with mildly decreased strength during dorsiflexion.  The CI underwent electrodiagnostic study in July 2008 that showed a normal study without evidence of a right lumbar radiculopathy, focal neuropathy, or generalized polyneuropathy.

The 25 June 2008 physical therapy examination showed thoracolumbar-repetitive ROM of flexion to 65 degrees (normal 90) and combined ROM was 205 degrees (normal 240) with pain limited motion.

During the 10 November 2008 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported constant sharp and aching low back pain; elicited by physical activity, sitting and standing.  There were no incapacitating episodes.  Physical examination showed a normal posture and gait without muscle spasm.  There was no radiating pain and straight leg raises test for radiculopathy was negative.  Motor strength and neurological examinations were normal.  ROM was flexion to 65 degrees and combined ROM was 215 degrees with painful motion.  Repetitive ROM did not result in additional limitation due to pain, fatigue weakness, lack of endurance or incoordination.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 20%, coded 5243 (invertebral disk syndrome), citing limitation of motion.  The VA rated the low back condition 10%, also coded 5243, based on the C&P examination 2 months before separation, also citing limitation of motion.

The panel agreed there was no ROM evidence to support a rating higher than the rating adjudicated by the PEB.  There was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the low back pain condition.

Contended PEB Condition:  Bilateral Posterior Tibial Tendon Dysfunction.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the chronic low back pain condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended bilateral posterior tibial tendon dysfunction condition, the panel recommends no change from the PEB determination as not unfitting.  There were no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150821, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170012160, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,