RECORD OF PROCEEDINGS
                     PHYSICAL DISABILITY BOARD OF REVIEW

NAME:                                                  BRANCH OF SERVICE:
Army
CASE NUMBER:  PD1100112                                        SEPARATION
DATE:  20041101
BOARD DATE:  20120215


SUMMARY OF CASE:  Data extracted  from  the  available  evidence  of  record
reflects that this covered individual (CI) was a  mobilized  National  Guard
SPC/E-4 (95B, Military Police) medically separated for  chronic  back  pain.
She was treated, but  did  not  respond  adequately  to  fully  perform  her
military duties  or  meet  physical  fitness  standards.   She  underwent  a
Medical  Evaluation  Board  (MEB).   The  back  pain  condition   (L5   pars
interarticularis fracture, without instability  of  the  lumbar  spine)  was
forwarded to the Physical Evaluation Board (PEB) as  medically  unacceptable
IAW AR 40-501.  Two other conditions (posttraumatic headache and  short-term
memory loss) were listed on the DA Form 3947 as medically  acceptable.   The
PEB found the back pain condition unfitting and rated it 10%.   The  CI  did
not  accept  the  PEB  findings  and  requested  reconsideration.    A   PEB
Reconsideration was performed, and the rating was increased to 20%  IAW  the
Veterans’ Administration Schedule for Rating Disabilities (VASRD).   The  CI
made  no  further  appeals,  and  was  thus  medically  separated  with  20%
disability.


CI CONTENTION:  The CI states, “after release I  had  several  surgeries  in
connection to the line of duties.”


RATING COMPARISON:

|Army (Informal Reconsid.) PEB –     |VA (7 mo. After Separation) – All    |
|dated 20040913                      |Effective 20041102                   |
|Condition            |Code          |Rating                               |
|Short-term Memory    |Not Unfitting |No Corresponding VA Entry for Memory |
|Loss                 |              |Loss                                 |
|Combined:  20%                      |Combined:  40%                       |


ANALYSIS SUMMARY:
The Board acknowledges the sentiment  expressed  by  the  CI  regarding  the
significant impairment with which her conditions  continue  to  burden  her.
The Board is subject to the same laws for  service  disability  entitlements
as those under which the DoD Disability Evaluation  System  (DES)  operates.
The DES has neither  the  role  nor  the  authority  to  compensate  service
members for anticipated  future  severity,  or  potential  complications  of
conditions.   That  role  and  authority  is  granted  by  Congress  to  the
Department of Veterans' Affairs (DVA).  The  Board’s  authority  resides  in
evaluating the fairness of DES fitness decisions and  rating  determinations
for disability at the time of separation.

Low Back Pain (LBP).  The  CI  injured  her  back  during  a  motor  vehicle
accident (MVA) in January 2004.  X-rays of the spine were  read  as  normal.
She was diagnosed with musculoskeletal pain and released to full duty.   Due
to persistent LBP, repeat x-rays were done  which  revealed  a  possible  L5
pars interarticularis fracture, and grade one  spondylolisthesis  at  L5-S1.
Her pain continued, and an MEB was initiated.  In April 2004  she  was  seen
by  physical  medicine  and  orthopedics.   Electrodiagnostic  studies  were
negative for radiculopathy.  Magnetic  Resonance  Imaging  (MRI)  showed  no
evidence of a fracture, but did show L5 spondylolysis.   Bone  scan  of  the
lumbar spine was negative.  At her April 2004 MEB exam, six months prior  to
separation, the CI reported constant, intense LBP.  Her posture was  normal.
 There was some tenderness  to  palpation  (TTP)  in  the  L4-L5  and  L5-S1
region.  Muscle strength, sensation and deep  tendon  reflexes  (DTRs)  were
normal.  Repeat bone scan again showed no uptake at L5.  The CI was  offered
surgery, but she chose non-operative management.  The CI was examined  again
in May 2004.  Motor, sensory, DTRs, straight leg raise (SLR),  and  heel/toe
walk were all normal.  Waddell’s signs were  positive  for  hypersensitivity
and distraction.  Range-of-motion (ROM) is shown in the chart below.

At her June 2005 VA Compensation and Pension (C&P) exam, seven months  after
separation, the CI reported constant LBP with  daily  flare-ups.   The  pain
was worse with bending, lifting and twisting.  On exam,  she  had  some  TTP
over the lumbar spine.  Lordosis was normal and no deformities  were  noted.
DTRs and motor strength were normal.  SLR in the  sitting  position  was  80
degrees bilaterally.  However, SLR while supine was only 45 degrees, due  to
pain.  Three full goniometric ROM evaluations were in  the  record  and  are
summarized below.

|Goniometric ROM      |25 weeks Pre-Sep|12½ weeks Pre-Sep|31 weeks       |
|Thoracolumbar        |(20040510)      |(20040806)       |Post-Sep       |
|                     |                |                 |(20050607)     |
|Flexion (90⁰ is      |60⁰             |40⁰              |20⁰            |
|normal)              |                |                 |               |
|Combined (240⁰ is    |175⁰            |150⁰             |110⁰           |
|normal)              |                |                 |               |
|Comments             |ROM limited by  |No mention of    |Marked pain    |
|                     |pain            |pain             |               |
|§4.71a Rating        |20%             |20%              |40%            |

The Board carefully reviewed all  evidentiary  information  available.   The
Board determined that the first two ROM evaluations  (May  2004  and  August
2004) had greater probative value, due to their proximity  to  the  date  of
separation.  The VA C&P exam on 7 June 2005 was more than six  months  after
separation.  There were also certain inconsistencies found in the June  2005
C&P exam which further diminished its probative value.   IAW  VASRD  §4.71a,
the CI’s limitation of thoracolumbar motion warrants a rating of 20%,  based
on forward flexion  greater  than  30⁰,  but  not  greater  than  60⁰.   The
treatment record did not show evidence of a significant  radiculopathy  that
would qualify  for  an  additional  rating.   There  was  also  insufficient
evidence of incapacitating episodes that  would  meet  the  rating  criteria
under code 5243 (intervertebral disc  syndrome).   After  due  deliberation,
and careful  consideration  of  all  the  evidence,  the  Board  unanimously
recommends a disability rating of 20% for the chronic LBP condition.

Other PEB Conditions.  Posttraumatic headaches and  short-term  memory  loss
were adjudicated by the PEB as not unfitting.  Neither of  these  conditions
were profiled, implicated in the commander’s statement, or noted as  failing
retention standards.  These conditions were reviewed by the  action  officer
and considered by the Board.  There was no indication from the  record  that
either  of  these  conditions  significantly  interfered  with  satisfactory
performance of required military duties.  All evidence considered, there  is
not reasonable doubt in the  CI’s  favor  supporting  reversal  of  the  PEB
fitness adjudication for either of the stated conditions.

Remaining Conditions.   Shoulder  dislocation,  hemorrhoids,  bladder  pain,
situational stress, shin splints, and several  other  conditions  were  also
noted  in  the  DES  file.   None  of  these  conditions   were   clinically
significant during the MEB/PEB period.  None of them  carried  profiles,  or
were  implicated  in  the  commander’s  statement.   These  conditions  were
reviewed by the  action  officer  and  considered  by  the  Board.   It  was
determined that none could be argued as unfitting and subject to  separation
rating.  The Board, therefore, has no reasonable basis for recommending  any
additional unfitting conditions for separation rating.


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.  In the matter of the low back pain  condition
and IAW VASRD §4.71a, the Board unanimously recommends no change in the  PEB
adjudication.  In the matter of  the  posttraumatic  headaches,  short  term
memory loss, shoulder dislocation, hemorrhoids,  bladder  pain,  situational
stress, shin splints, or any other conditions  eligible  for  consideration;
the Board unanimously agrees that it cannot recommend any findings of  unfit
for additional rating at separation.


RECOMMENDATION:  The Board, therefore, recommends that there be no
recharacterization of the CI’s disability and separation determination.

|UNFITTING CONDITION                               |VASRD CODE  |RATING  |
|Chronic Back Pain                                 |5235        |20%     |
|COMBINED    |20%     |


The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20110316 w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record





                 President
                 Physical Disability Board of Review
SFMR-RB


MEMORANDUM FOR Commander, US Army Physical Disability Agency


SUBJECT:  Department of Defense Physical Disability Board of Review
Recommendation


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
                                       Deputy Assistant Secretary
                                           (Army Review Boards)