RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY CASE NUMBER: PD1200979 SEPARATION DATE: 20020802 BOARD DATE: 20130222 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (12B20/Combat Engineer), medically separated for mechanical non-radicular mid low back pain (LBP). The mechanical non-radicular mid LBP condition could not be adequately rehabilitated. The CI did not improve adequately with treatment to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The MEB forwarded mechanical to mid LBP for Physical Evaluation Board (PEB) adjudication. The PEB adjudicated the mechanical non-radicular mid LBP condition as unfitting, rated 10%. The CI made no appeals, and was medically separated with a 10% disability rating. CI CONTENTION: “The Rating was given for my feet. My feet overtime I believe caused my knee, back and neck injuries because of my extreme duty assignments and requirement of AirBorne service and sustained injuries to my feet complicated the rest of my body.” SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2) is limited to those conditions which were determined by the PEB to be specifically unfitting for continued military service; or, when requested by the CI, those condition(s) “identified but not determined to be unfitting by the PEB.” The ratings for unfitting conditions will be reviewed in all cases. The mechanical non-radicular mid LBP condition as requested for consideration meet the criteria prescribed in DoDI 6040.44 for Board purview; and, is addressed below, in addition to a review of the ratings for the unfitting condition. The other requested conditions [neck, knee and neck] are not within the Board’s purview. The remaining conditions rated by the VA at separation and listed on the DA Form 294 are not within the Board’s purview. Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Army Board for Correction of Military Records. RATING COMPARISON: Service IPEB – Dated 20020802 VA (~1 Mo. Post-Separation) – All Effective Date 20020904 Condition Code Rating Condition Code Rating Exam Mechanical Non-Radicular Mid Low Back Pain 5299-5295 10% NSC .No Additional MEB/PEB Entries. Pes Planus, Plantar Fasciitis and Spurring, Left Calcaneous 5276-5284 10% 20091202 Pes Planus, Plantar Fasciitis, and Spurring, Right Foot 5276-5284 10% 20091202 Not Service-Connected x 9 Combined: 10% Combined: 20% ANALYSIS SUMMARY: The Disability Evaluation System (DES) is responsible for maintaining a fit and vital fighting force. While the DES considers all of the member's medical conditions, compensation can only be offered for those medical conditions that cut short a member’s career, and then only to the degree of severity present at the time of final disposition. The DES has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation nor for conditions determined to be service-connected by the Department of Veterans Affairs (DVA) but not determined to be unfitting by the PEB. However the DVA, operating under a different set of laws (Title 38, United States Code), is empowered to compensate all service-connected conditions and to periodically re-evaluate said conditions for the purpose of adjusting the Veteran’s disability rating should the degree of impairment vary over time. The Board’s role is confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to Veterans Affairs Schedule for Rating Disabilities (VASRD) standards, based on severity at the time of separation. Mechanical Non-Radicular Mid Low Back Pain Condition. At the MEB examination, the CI reported that he had lower back pain following a 30 foot fall from a repelling tower in 1997. The CI reported that his back pain worsened even with mild physical exertion and limited him from performing his duties. The CI reported taking Ibuprofen prior to physical activity and Tylenol when pain prevented him from sleeping. There was reference to X-ray examination of the thoracic spine, 6 December 1999 which was normal. A bone scan of the spine on 7 April 2000 revealed a healing fracture of the left 10th rib but was otherwise normal. A magnetic resonance imaging (MRI) scan of the lumbar spine 7 November 2001 was normal. There was no evidence of intervertebral disc abnormalities or herniation. The MEB narrative summary (NARSUM) physical examination on 22 May 2002 noted that the CI’s spine was in line, without step-off or deformity. The CI had “minimal” tenderness to palpation on the lower lumbar spine and in the right sacroiliac joint. Straight leg examination was negative bilaterally. Muscle strength, reflexes and sensation were normal. The MEB NARSUM cited range-of-motion (ROM) examinations performed by physical therapy. Physical therapy examinations performed 10 February 2000 and 15 August 2001, both more than a year prior to separation demonstrated mild limitation of motion. The physical therapy examination most proximate to separation was performed 27 March 2002 and reported flexion of 110 degrees, extension 15 degrees, lateral flexion (side bending) of 20 degrees to both sides and rotation of 35 degrees to both sides. No VA Compensation and Pension (C&P) examination that is proximate to separation is in evidence however a subsequent VA rating decision dated 2 December 2009 noted service-connection was denied for LBP “because the evidence failed to show evidence of a lumbar spine condition to warrant a finding of service connection.” The Board directs attention to its rating recommendation based on the above evidence. The Board notes that the 2002 VASRD standards for the spine, which were in effect at the time of separation, were changed to the current §4.71a rating standards in 2004. In accordance with DoDI 6040.44, the Board is required to recommend a rating IAW the VASRD in effect at the time of separation. The Board must correlate the above clinical data with the 2002 rating schedule. The applicable diagnostic codes include: 5292 limitation of lumbar spine motion, and 5295 lumbosacral strain). There was no evidence of intervertebral disc disease to warrant consideration under corresponding code 5293. The PEB rated the back pain condition 10% using the VASRD code 5295 for lumbar strain citing painful motion. As noted, the VA did not find a ratable disability. The Board considered the VASRD diagnostic code 5292 for limitation of lumbar spine motion in effect at the time and noted there was no more than slight limitation supporting a 10% rating under this code providing no benefit to the CI. Regarding the rating under 5295, lumbosacral strain, the Board reviewed the clinical records and found no evidence supporting a rating higher than the 10% rating assigned by the PEB. The CI complained of pain on motion limiting his mobility at times. There was no evidence of the symptoms consistent with listing of the entire spine (twisted to one side), Goldthwaite’s sign, marked limitation of forward bending while standing, or loss of lateral motion with osteo-arthritic changes, or narrowing or irregularity of joint space narrowing or irregularity of joint space, or some other abnormal mobility with forced motion. This would eliminate the rating for severe under this code. There was no evidence of muscle spasm on extreme forward bending reported on the MEB examination. Lateral spine motion, although decreased from all prior examination, was within normal limits on the MEB exam and there was no reported unilateral loss of lateral spine motion in the standing position. The condition did not meet the criteria for the 20% rating but there was consistent evidence of pain on motion which supports the 10% 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 mechanical non-radicular mid LBP condition. BOARD FINDINGS: IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication. The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised. In the matter of the, mechanical non-radicular mid LBP condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. There were no other conditions within the Board’s scope of review for consideration. RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows: UNFITTING CONDITION VASRD CODE RATING Mechanical Non-Radicular Mid Low Back Pain Condition 5299-5295 10% COMBINED 10% The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20120610, w/atchs Exhibit B. Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record xxxxxxxxxxxxxxxxxxxxxxxxx, DAF Acting Director Physical Disability Board of Review SFMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (TAPD-ZB / xxxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for xxxxxxxxxxxxxxxxxxxxxxxxxx, AR20130005545 (PD201200979) 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: Encl xxxxxxxxxxxxxxxxxxxxxxxx Deputy Assistant Secretary (Army Review Boards)