RECORD OF PROCEEDINGS
                     PHYSICAL DISABILITY BOARD OF REVIEW

NAME:                                        BRANCH OF SERVICE:  Army
CASE NUMBER:  PD1100232                                    SEPARATION  DATE:
20051012
BOARD DATE:  20120321


SUMMARY OF CASE:  Data extracted  from  the  available  evidence  of  record
reflects that this covered  individual  (CI)  was  an  Active  Guard/Reserve
(AGR) SSG/E-6 (42A, Human Resources) medically  separated  for  chronic  low
back pain (LBP) and chronic  neck  pain.   She  was  treated,  but  did  not
respond adequately to fully perform her military duties.   She  underwent  a
Medical Evaluation Board (MEB).  Mechanical LBP and cervical neck pain  were
forwarded to the Physical Evaluation Board (PEB) as  medically  unacceptable
IAW AR 40-501.  Eight other conditions, as identified in  the  rating  chart
below, were listed on the MEB submission as medically acceptable.   The  PEB
found the LBP and neck pain conditions unfitting, and rated those 10%  each.
 The other MEB conditions were all  found  to  be  not  unfitting,  and  not
ratable.  The CI made  no  appeals,  and  was  thus  separated  with  a  20%
combined disability rating.


CI CONTENTION:  The CI states, “I deal  with  the  pain  and  have  to  take
medication on a daily basis.  I have  had  injections  administered  in  the
lower back and having to take more medication due  to  pain  worsening  over
time.  I am currently in a job profession that I cannot see  myself  in  too
much longer due to progression of the pain in my  lower  back  and  pain  in
neck and shoulders.  Before I entered the military and had the  accident  in
1995, I use to run and lift weights with no problem.  I never had  an  issue
with pain or with my weight.   Since  the  accident  and  starting  to  have
issues with my neck and  shoulders  I  have  had  problems  with  exercising
consistantly due to the pain.  Therefore this has caused  problems  with  my
weight and  I  have  dealt  with  emotional  turmoil  due  to  this.   I  am
considered obese due to medical charts.  My employer  is  requiring  that  I
complete a Physical Readiness Test (PRT) and maintain a  height  and  weight
standard.  For days after completing the PRT I suffer from the  pain  in  my
lower back and neck/shoulders and have failed the tests  before  and  failed
to meet the standards for height and weight.  I have continued  to  struggle
with this vicious cycle of physical and emotional pain that I have  acquired
due to the accident and other things in the military.  I  also  have  to  be
treated for acne and migraines on a regular basis.”


















RATING COMPARISON:

|Army PEB – dated 20050705      |VA (11 mos. Post-Separation) – All       |
|                               |Effective 20051013                       |
|Condition                      |Code                              |Rating |
|Combined:  20%                 |Combined:  50% (*initially 40%)          |


*Three VA Rated Conditions were initially “NSC.”  Service Connection was
granted later, and the Combined VA Rating was increased to 50%


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  Disability  Evaluation  System  (DES)
operates.  The DES has neither the role  nor  the  authority  to  compensate
service  members  for  future  severity  or   potential   complications   of
conditions resulting in medical separation.   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 at the time of  separation.   The  Board
also acknowledges  the  CI’s  contention  that  service  ratings  should  be
granted for other conditions.  While the  DES  considers  all  of  the  CI's
medical conditions, compensation can only be offered  for  those  conditions
that cut short a service member’s career, and then only  to  the  degree  of
severity present at the time of separation.  The DVA, however, is  empowered
to compensate 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.

Low Back Pain (LBP).  The CI injured her back while  rappelling  in  January
1995.  Her symptoms progressed over time.  Magnetic resonance imaging  (MRI)
revealed  some  levoscoliosis,   with   transitional   appearance   of   the
lumbosacral junction.  Due to her persistent LBP, an MEB was initiated.   At
the June 2005 MEB exam, 19 weeks prior to separation, the  CI  reported  LBP
which was worse after prolonged  sitting.   On  examination,  she  had  some
lumbar tenderness.  Motor exam, sensory exam, straight leg raise (SLR),  and
heel/toe  walk  were  all  intact.   X-rays  of  the   lower   back   showed
sacralization of L5, but were otherwise normal.  The CI failed to  show  for
her  scheduled  VA  exam,  so  there  were  no  VA   range-of-motion   (ROM)
measurements  proximal   to   separation.    Her   MEB   thoracolumbar   ROM
measurements are summarized  below.

|Thoracolumbar       |Separation Date:      |
|                    |20051012              |
|Goniometric ROM     |MEB – 19 wks. Pre-Sep |
|Flexion (90⁰ is     |90⁰                   |
|normal)             |                      |
|Combined (240⁰ is   |225⁰                  |
|normal)             |                      |
|§4.71a Rating       |10%                   |
|Comments            |No mention of pain    |
|                    |with ROM              |


The Army PEB and the VA both rated her back pain condition at 10%.  IAW  the
Veterans’ Administration Schedule for Rating  Disabilities  (VASRD)  §4.71a,
her LBP condition does indeed warrant a  rating  of  10%,  due  to  combined
thoracolumbar ROM  greater  than  120  degrees  but  not  greater  than  235
degrees.  Although there was some thoracic  scoliosis,  the  evidence  shows
that this was not due to severe muscle spasm or guarding.   There  was  also
insufficient  evidence  of  a  separately  unfitting  peripheral  neuropathy
(radiculopathy) present at the time of separation.  After  due  deliberation
and careful review of  all  available  evidentiary  information,  the  Board
unanimously recommends a disability rating of 10%  for  the  low  back  pain
condition.  It is appropriately coded 5299-5237 and IAW VASRD §4.71a,  meets
criteria for the 10% rating.

Neck Pain.  In January 2003, the CI began having neck pain that radiated  to
her upper shoulders.  MRI of the cervical  spine  in  February  2004  showed
some  straightening  of  the  cervical   curvature,   but   no   significant
abnormalities.  Cervical x-rays  in  May  2005  were  normal.   The  CI  was
treated with physical therapy (PT) and chiropractic care.  She  used  Motrin
on an “as needed” basis for her neck pain symptoms.  At her  June  2005  MEB
exam, 19 weeks prior to separation, the CI had cervical  tenderness,  and  a
negative Spurling test.  There were no neurological abnormalities.  Her  MEB
cervical ROM measurements are summarized in the chart below.

|Cervical spine      |Separation Date:      |
|                    |20051012              |
|Goniometric ROM     |MEB – 19 wks. Pre-Sep |
|Flexion (45⁰ is     |40⁰                   |
|normal)             |                      |
|Combined (340⁰ is   |275⁰                  |
|normal)             |                      |
|§4.71a Rating       |10%                   |
|Comments            |No mention of pain    |
|                    |with ROM              |

The Board carefully considered all the available evidence.   The  PEB  rated
her neck pain at 10%.  IAW VASRD §4.71a,  her  neck  condition  does  indeed
warrant a rating of 10%, due to combined cervical ROM greater than 170⁰  but
not greater than 335⁰.  Although there was some straightening  of  curvature
seen on MRI, the evidence shows that this was not due  to  severe  spasm  or
guarding.  There was also insufficient evidence of  a  separately  unfitting
cervical radiculopathy at the time of separation.  After  due  deliberation,
and  mindful  of  VASRD  §4.3  (reasonable  doubt),  the  Board  unanimously
recommends a disability rating of 10% for the neck pain  condition.   It  is
appropriately coded 5299-5237 and meets criteria for the 10% rating.

Other PEB  Conditions.   Foot  pain  (post-bunionectomy),  migraines,  acne,
asthma, elbow pain, knee pain, dyspepsia and abnormal  pap  smear  were  all
adjudicated by the PEB as not unfitting.   None  of  these  conditions  were
profiled, or implicated in the commander’s statement.  All were reviewed  by
the action officer and considered by the Board.   There  was  no  indication
from the record that any of these conditions significantly  interfered  with
satisfactory performance  of  military  duties.   All  evidence  considered,
there is not reasonable doubt in the CI’s favor supporting reversal  of  the
PEB fitness adjudication for any of the stated conditions.

Remaining  Conditions.    Shoulder   pain,   obesity,   emotional   turmoil,
allergies, left breast cyst, bronchitis, and several other  conditions  were
also  noted  in  the  file.   None  of  these  conditions  were   clinically
significant during the MEB/PEB period, none carried profiles and  none  were
implicated in the commander’s statement.  These conditions were reviewed  by
the action officer and considered by  the  Board.   There  was  insufficient
evidence for concluding that any of these conditions  interfered  with  duty
performance to a degree that  could  be  argued  as  unfitting.  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,  the  Board  unanimously  recommends  no  change   in   the   PEB
adjudication.   In  the  matter  of  the  neck  pain  condition,  the  Board
unanimously recommends no change in the PEB adjudication.  In the matter  of
the foot pain, migraines, acne, asthma, elbow pain,  knee  pain,  dyspepsia,
abnormal pap smear, shoulder pain, obesity,  emotional  turmoil,  allergies,
breast  cyst,   bronchitis,   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, as
follows:

|UNFITTING CONDITION                               |VASRD CODE  |RATING  |
|Chronic Low Back Pain                             |5299-5237   |10%     |
|Chronic Neck Pain                                 |5299-5237   |10%     |
|COMBINED    |20%     |


The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20110328, 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)