RECORD OF PROCEEDINGS
                     PHYSICAL DISABILITY BOARD OF REVIEW

NAME:       BRANCH OF SERVICE:  Army
CASE NUMBER:  PD1100562      SEPARATION DATE:  20090811
BOARD DATE:  20120123


SUMMARY OF CASE:  Data extracted  from  the  available  evidence  of  record
reflects that this covered  individual  (CI)  was  an  active  duty  SPC/E-4
(15U10 /Helicopter Repairman), medically  separated  for  chronic  low  back
pain (LBP).  His symptoms began  in  2007  after  a  series  of  falls,  and
included  occasional  pain  radiation  and  numbness  down  the  left   leg.
Radiologic  studies  were  normal.   His  treatment  included   medications,
physical  therapy,  chiropractic  manipulation,  and  facet  joint   steroid
injection.  He did not respond adequately to treatment  and  was  unable  to
perform within his Military Occupational Specialty (MOS)  or  meet  physical
fitness standards.  He was issued a permanent L3  profile  and  underwent  a
Medical Evaluation Board (MEB).  Chronic LBP was forwarded to  the  Physical
Evaluation Board (PEB) as medically unacceptable IAW AR  40-501.   No  other
conditions appeared on the MEB’s submission.  Other conditions  included  in
the Disability Evaluation System (DES) file are discussed  below.   The  PEB
adjudicated the LBP condition as unfitting, rated 20%  with  application  of
the Veterans Administration Schedule for Rating Disabilities  (VASRD).   The
CI did not appeal for a Formal PEB, and was medically separated with  a  20%
disability rating.


CI CONTENTION:  “I am  unable  to  exercise  in  a  manner  consistent  with
maintaining a suitable training program.  The condition has caused  hardship
on  my  ability  to  find  gainful  employment.    [continuation]    Finding
employment of a suitable standing has proven difficult due  to  back  injury
and PTSD.”  He  elaborates  no  specific  contentions  regarding  rating  or
coding and mentions  no  additionally  contended  conditions.   All  service
conditions are reviewed by the Board for  their  potential  contribution  to
its rating recommendations.


RATING COMPARISON:

|Service PEB – Dated 20090504   |VA (~10 Mo. After Separation) – All     |
|                               |Effective Date 20090812                 |
|Condition                      |Code                            |Rating |
|Combined:  20%                 |Combined:  30%                          |


ANALYSIS SUMMARY:  The Board acknowledges the  sentiment  expressed  in  the
CI’s  application  regarding  the  significant  impairment  with  which  his
service-aggravated condition  continues  to  burden  him.   It  is  a  fact,
however, that the DES has neither the role nor the authority  to  compensate
Service members for anticipated future severity or  potential  complications
of conditions resulting in medical separation.  This role and  authority  is
granted by Congress to the Department of Veterans’ Affairs (DVA).  The  DVA,
operating under a different set of laws (Title 38, United States  Code),  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 his degree  of  impairment  vary  over  time.   The
Board  uses  DVA  evidence  proximate  to  separation  in  arriving  at  its
recommendations;  and,  DoDI  6040.44  defines  a                   12-month
interval  for  special  consideration  to  post-separation  evidence.    The
Board’s  authority  as  defined  in  DoDI  6040.44;  however,   resides   in
evaluating the fairness of DES fitness determinations and  rating  decisions
for  disability  at  the  time  of  separation.   Post-separation   evidence
therefore is probative only to the extent that it  reasonably  reflects  the
disability and fitness implications at the time of  separation.   The  Board
also  acknowledges  the  CI’s  contention  for  Service  ratings  for  other
conditions [posttraumatic stress disorder (PTSD)] documented at the time  of
separation, and notes that its recommendations  in  that  regard  must  also
comply with the same  governance.   While  the  DES  considers  all  of  the
Service member's medical conditions, compensation can only  be  offered  for
those medical conditions that cut short a Service member’s career, and  then
only to the degree of severity present at the  time  of  final  disposition.
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.

Chronic Low Back Pain.   There  were  three  thoracolumbar  spine  exams  in
evidence proximate to separation, including two goniometric range of  motion
(ROM) evaluations, with documentation of additional ratable criteria,  which
the Board weighed in arriving at its  rating  recommendation.   These  exams
are summarized in the chart below.

|Goniometric  |Ortho ~ 6 mos  |MEB (PT) ~ 5 Mo. |VA C&P ~ 10 Mo. Post-Sep |
|ROM -        |Pre-Sep        |Pre-Sep          |                         |
|Thoracolumbar|               |                 |                         |
|Flex (0-90)  |45⁰            |(40, 40, 40) 40⁰ |45⁰                      |
|Ext (0-30)   |-              |(20, 20, 20) 20⁰ |10⁰                      |
|L Lat Flex   |-              |(14, 14, 14) 15⁰ |30⁰                      |
|0-30)        |               |                 |                         |
|R Lat Flex   |-              |(15, 15, 15) 15⁰ |30⁰                      |
|(0-30)       |               |                 |                         |
|L Rotation   |-              |(18, 18, 18) 20⁰ |15⁰ (used cervical region|
|(0-30)       |               |                 |to move)                 |
|R Rotation   |-              |(21, 21, 21) 20⁰ |15⁰ (used cervical region|
|(0-30)       |               |                 |to move)                 |
|COMBINED     |Min 45⁰, Max   |130⁰             |145⁰                     |
|(240)        |195⁰           |                 |                         |
|Comment      |Painful motion,|Pain at rest     |Palpable muscle spasm,   |
|             |SLR neg, gait  |4/10, CI reports |guarding, TTP, SLR neg,  |
|             |normal, heel- &|limited mobility |Deluca – no fatigability |
|             |toe-walking    |due to pain,     |or loss of endurance, but|
|             |normal, neg    |Waddell signs    |there is pain with 3     |
|             |Patrick/Fabere |absent; NARSUM   |repetitions, gait normal,|
|             |, neg          |exam 20090302 –  |neuro normal             |
|             |Waddell’s,     |normal alignment,|                         |
|             |neuro normal   |no other         |                         |
|             |               |abnormalities    |                         |
|§4.71a Rating|≥20%           |20%              |20%                      |

Two outpatient physical medicine and rehabilitation  notes,  eight  and  ten
months                    pre-separation, stated ROM was “full,” with  “pain
at ends of ROM, especially with  extension/flexion,”  but  did  not  provide
goniometric measurements, and are thus excluded from the above  chart.   The
remainder of exam was normal on both occasions.  The first of these  entries
was for a facet joint injection,  the  latter  was  for  follow-up  of  that
injection.  The facet injection did not provide  relief,  and  the  examiner
suggested injecting the left sacroiliac (SI) joint, although no positive  SI
joint findings were noted.  An outpatient orthopedic note, six  months  pre-
separation, reported limited forward flexion  (meeting  20%  criterion)  and
painful motion, but did not provide other ROMs.  The remainder of  the  exam
was normal, including straight leg  raises,  gait,  heel-  and  toe-walking,
tests for sacroiliac joint dysfunction (Patrick’s/Fabere), Waddell’s  signs,
and  neurological  evaluation.   The  examiner  noted  a   normal   magnetic
resonance imaging (MRI) and stated surgery was not indicated.

The MEB ROM evaluation, performed by physical therapy (PT) five months  pre-
separation, reported reduced ROMs (meeting the 20% criterion  for  flexion),
and a history of pain-limited motion.  The exam was  a  ROM-only  exam,  but
noted the absence of Waddell’s signs.  The physical  exam  reported  in  the
narrative summary (NARSUM), the same month as the PT ROM exam, noted  normal
spinal alignment, and no abnormalities.  Lumbar  radiographs  and  MRI  were
normal.

The VA Compensation and Pension (C&P)  exam,  10  months  after  separation,
reported similarly limited ROMs  (meeting  the  20%  criterion  for  forward
flexion), palpable muscle spasm,  guarding,  tenderness  to  palpation,  and
pain with repetitive movement.   Negative  findings  included  normal  gait,
negative straight leg raises,  and  normal  neurologic  evaluation.   Lumbar
radiographs were normal. VA C&P exam 23 months  after  separation  indicated
post-separation improvement in the LBP condition.

There  were  no  reports  of  incapacitating  episodes  requiring  bed  rest
prescribed by a physician and treatment by  a  physician,  as  required  for
rating  under  intervertebral  disc  syndrome,  so  the  condition  is  most
appropriately rated using  the  General  Rating  Formula  for  Diseases  and
Injuries of the  Spine.   Coding  in  this  case  would  optimally  be  5237
(lumbosacral strain) as used by both  the  PEB  and  VA.   Both  exams  most
proximate to separation would rate 20% IAW the General Rating Formula.   The
record did not  provide  evidence  the  CI’s  condition  ever  met  the  40%
criteria of that formula, requiring forward flexion of 30 degrees  or  less,
or favorable ankylosis of the  entire  thoracolumbar  spine.   All  evidence
considered, there is not reasonable doubt in the  CI’s  favor  supporting  a
change from the PEB’s rating decision for the low back pain condition.

LBP  Condition  (Radiculopathy).   There  was  no  evidence   of   unfitting
peripheral  nerve  impairment  in  this  case.   The  CI  endorsed  episodic
radiation of his pain into his left leg and occasional numbness of his  left
leg.  Any pain-radiculopathy is considered  above  under  the  CI’s  primary
unfitting lumbosacral condition IAW the General Rating Formula for  Diseases
and Injuries of the Spine, “With or without symptoms such as  pain  (whether
or not it radiates), stiffness, or aching in the area of the spine  affected
by residuals of injury or disease.”  Neurological  evaluation  proximate  to
separation was  normal,  including  motor,  sensory,  and  reflexes.   Lower
extremity motor function was normal throughout the record,  without  atrophy
or  foot  drop.   MRI  did  not  provide  evidence  of  disc  herniation  or
neuroforaminal compromise.  This leaves no grounds for Board  recommendation
of an additionally unfitting neuropathy.  All evidence considered, there  is
not reasonable doubt in the CI’s favor  supporting  addition  of  any  lower
extremity radiculopathy as an unfitting condition for separation rating.

Other Contended Conditions.  The CI’s application asserts  that  compensable
ratings should be considered for PTSD.  The CI had an S1 profile  and  there
were no restrictive comments attributable to  any  mental  disorder  in  the
commander’s statement or DES file.  PTSD  was  not  documented  in  the  DES
file.  The Board does not have the authority under DoDI  6040.44  to  render
fitness or rating recommendations for any conditions not considered  by  the
DES.  Contended conditions which are not eligible for Board  recommendations
on this  basis  remain  eligible  for  submission  to  the  Army  Board  for
Correction  of  Military  Records  (ABCMR).   The  Board  therefore  has  no
reasonable basis for recommending any additional  unfitting  conditions  for
separation rating.

Remaining Conditions.  Other conditions identified  in  the  DES  file  were
right foot pain status post surgery, hyperlipidemia, mild acne on  neck  and
back, and allergic rhinitis.  Several  additional  non-acute  conditions  or
medical complaints were also documented.   None  of  these  conditions  were
occupationally significant during the  MEB  period,  none  carried  attached
profiles, and none 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.  Additionally chronic adjustment  disorder  with  anxiety
(VA 10%) was noted in a VA rating decision proximate to separation, but  was
not documented in the DES file.  The  Board  does  not  have  the  authority
under DoDI 6040.44 to render  fitness  or  rating  recommendations  for  any
conditions  not  considered  by  the  DES.   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.  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 low  back  pain  condition  and  IAW  VASRD
§4.71a, the Board unanimously recommends no change in the PEB  adjudication.
  In  the  matter  of  any  other  medical  conditions  eligible  for  Board
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                           |5237        |20%     |
|COMBINED    |20%     |


The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20110729, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SFMR-RB


MEMORANDUM FOR Commander, US Army Physical Disability Agency
Crystal Drive, Suite 300, Arlington, VA 22202

SUBJECT:  Department of Defense Physical Disability Board of Review
Recommendation for (PD201100562)


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

CF:
(  ) DoD PDBR
(  ) DVA