RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW
BRANCH OF SERVICE: ARMY
SEPARATION DATE: 20041105
NAME: XXXXXXXXXXXXXXXX
CASE NUMBER: PD1200165
BOARD DATE: 20121116
SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this
covered individual (CI) was a National Guard PV2/E‐2 (15T/Blackhawk Helicopter Mechanic),
medically separated for mechanical low back pain. The low back pain condition did not
improve adequately with treatment and the CI was unable 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 no other conditions for Physical Evaluation Board (PEB) adjudication. The PEB
adjudicated the low back pain condition as unfitting, rated 10% with application of the
Veteran’s Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals, and was
medically separated with a 10% disability rating.
CI CONTENTION: “The Army only rated me for my back. My bilateral knee condition was also
well documented in my file and led just as much to my inability to perform as a soldier. My
initial rating from the VA after separation was 20% for my back, 20% for my right knee, and 20%
for my left knee. “
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 unfitting low back pain condition
meets the criteria prescribed in DoDI 6040.44 for Board purview, and is accordingly addressed
below. The other requested conditions of right and left knee conditions 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:
*80% from 20101109 per VARD 20111110
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
Service IPEB – Dated 20040908
Condition
Code
5237
Rating
10%
Mechanical Low Back Pain
↓No Addi(cid:415)onal MEB/PEB Entries↓
Combined: 10%
VA 1 Month After Separation – All Effective Date 20041106
Condition
Herniated Disk, Lumbar Back
Pain
Left Knee Strain
Right Knee Strain
Code
5242
5261
5261
Rating
20%
20%
20%
Exam
20051207
20051207
20051207
Not Service‐Connected x 1
Combined: 50%
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 his 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 VASRD standards, based on severity at the time of
separation. The Board utilizes DVA evidence proximal 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 6044.40, 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.
Mechanical Low Back Pain Condition. There were four goniometric ranges‐of‐motion (ROM)
evaluations in evidence, with documentation of additional ratable criteria, which the Board
weighed in arriving at its rating recommendation. A physical therapy examination reported
lumbar ROM using a dual inclinometer method and is not recorded in the chart but described in
the text below. Three examinations reporting thoracolumbar ROM are summarized in the chart
below.
MEB
~3 Mo. Pre‐Sep
(20040804)
VA General C&P
~ 12 Mo. Post‐Sep
(20051128)
VA Spine C&P
~13 Mo. Post‐Sep
(20051207)
At the orthopedic MEB narrative summary (NARSUM) exam performed on 04 August 2004,
3 months before separation, the CI reported acute onset of low back pain in February of 2004
when he fell on a Leadership Development Course in AlT. The CI fell flat on his back not from a
height and had the onset of pain since that time. He underwent physical therapy, activity
modification and time with no improvement in his symptoms and had significant duty
limitations because of his pain. Magnetic resonance imaging (MRI) of the lumbar spine
performed on 21 May 2004 demonstrated a disc protrusion at L5‐S1 without evidence of
impingement on any nerves. The orthopaedic MEB NARSUM stated the majority of the CI’s
pain, 80 to 90%, was in his lower back with occasional radiation bilaterally to legs extending
down primarily the posterior aspect of the legs to the knees, left side worse than right. The
NARSUM physical exam revealed tenderness of midline spinous processes L3 to S1 and minimal
paraspinal tenderness. No noted paraspinal muscle spasm. ROM (in chart) was limited by pain.
There was pain into the posterior left thigh with straight leg rising, however reflexes and
strength were normal. Pain on axial loading was documented on this examination, a maneuver
2 PD12‐00165
70
15
Thoracolumbar ROM
(Degrees)
Flexion (90 Normal)
Extension (30)
R Lat Flex (30)
L Lat Flex (30)
R Rotation (30)
L Rotation (30)
Combined (240)
Comment
§4.71a Rating
55
10
25
25
30
30
175
20%
80
25
25
30
40
35
220
Pain at end range.
No change with
repetition.
Tenderness.
No muscle spasm.
Limp on the left.
10%
Limited by pain.
Tenderness.
No muscle spasm.
Normal appearance.
See text for PT exam
same date.
10%
ROM after repetition.
Tight muscles
Abnormal gait.
Abnormal contour.
not expected to cause pain. Physical therapy performed a lumbar ROM examination on the
same date as MEB NARSUM, 4 August 2004, using the dual inclinometer method that measures
isolated lumbar spine motion, not thoracolumbar ROM used by the VASRD for rating purposes.
Lumbar flexion was recorded as 60, 60, and 64 degrees limited by pain. The normal lumbar
ROM by the dual inclinometer method is 60 degrees. When combined with a normal thoracic
ROM, this would represent normal thoracolumbar flexion.
The orthopedic surgeon
documented a thoracolumbar flexion of 70 degrees on the same date. The physical therapist
reported that lumbar extension was 14, 10, 10 degrees; right lateral flexion 30, 26, 28 degrees;
left lateral flexion 24, 26, 26 degrees; right rotation 40, 40, 40 degrees; and left rotation 45, 45,
45 degrees (rotation measured with goniometer and consistent with VASRD ROM
requirements), all limited by report of pain. The physical therapist noted an abnormal posture
while the orthopedic surgeon reported a normal appearing spine on the same date. At the VA
Compensation and Pension (C&P) general medical examination exam 28 November 2005,
12 months after separation, the CI reported constant daily back pain with daily flares of pain
due to activity, bending, stooping and lifting. However, the CI reported only occasionally taking
Motrin and Tylenol. The CI stated he fell off a platform during AIT course. Examination
revealed tightness of the paravertebral muscles, no tenderness. Physical exam revealed an
antalgic gait with normal station. A modest levoscoliosis with increased kyphosis and
decreased lordosis, and a 10 degree list of the pelvis to the left. There was no pain with straight
leg raising. ROM were decreased compared to prior examinations (see chart) and the CI was
noticeably uncomfortable and fatigued with repetitive motion of the lumbar spine. At the spine
C&P examination on 7 December 2005, 13 months after separation. The CI stated he fell about
10 feet onto his back. He denied any back injuries prior or subsequent to that. Pain was 7/10;
no radiating symptomatology to the lower extremities; no flare ups; no current treatment; no
treatment by a doctor in the past 12 months; can walk half a mile and sit for 30 minutes at a
time. Physical examination revealed a left limp, level pelvis, slight tenderness to palpation of
the right and left paralumbar muscles, and no muscle spasm. Thoracolumbar ROM was
improved from the month before, did not change after repetition and was consistent with the
MEB NARSUM examination 3 months before separation. Straight leg raising was negative,
sensation and reflexes intact, and strength normal (except for mild weakness of the left
quadriceps associated with complaint of knee pain). The Board directs attention to its rating
recommendation based on the above evidence. The MEB NARSUM examination was consistent
with the 10% rating adjudicated by the PEB and was in accordance with the general rating
formula for rating diseases and injuries of the spine. The Board noted the subsequent C&P
examinations 12 and 13 months after separation. The general C&P examination alone is
consistent with the 20% rating adjudicated by the VA, while the spine C&P examination a
month afterwards is consistent with a 10% rating. The Board noted the MEB examinations
were more proximate to the time of separation, and that the VA spine examination was
consistent with the MEB examination. While the total clinical picture may vary from date to
date, the Board concluded the preponderance of evidence more nearly approximated the 10%
rating at the time of separation. The Board also considered a rating using the VASRD formula
based on incapacitating episodes due to intervertebral disc syndrome (as the CI was shown to
have disc disease). The criteria are based on the number of incapacitating episodes in the prior
12 months requiring bed rest prescribed by a physician. No service treatment records (STR)
were identified that documented physician directed bed rest. Thirteen months after
separation, the C&P examination documented the CI did not seek medical treatment for this
condition and only occasionally took over the counter medications for pain. The Board
concluded the preponderance of evidence did not support a higher rating using this alternate
formula providing no additional benefit to the CI. There was no associated radiculopathy for
separate peripheral nerve rating. Although the CI experienced radiating pain, there was no
objective evidence of a radiculopathy or functional impairment with a direct impact on fitness.
While the CI may have experienced radiating pain from the back condition, this is subsumed
under the general spine rating criteria, which specifically states “with or without symptoms
3 PD12‐00165
such as pain (whether or not it radiates).” There is no evidence in this case that there was
radiculopathy with associated functional impairments separately functionally impairing. The
Board therefore concludes that additional disability rating was not justified on this basis. 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 low back pain 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. In the matter of the
mechanical low back pain 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.
UNFITTING CONDITION
VASRD CODE
RATING
Mechanical Low Back Pain
The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20120214, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record
5237
COMBINED
10%
10%
XXXXXXXXXXXXXX, DAF
President
Physical Disability Board of Review
4 PD12‐00165
SFMR‐RB
MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD‐ZB / XXXXXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA 22202‐3557
SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for
XXXXXXXXXXXXX, AR20130000035 (PD201200165)
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
XXXXXXXXXXX
Deputy Assistant Secretary
(Army Review Boards)
CF:
( ) DoD PDBR
( ) DVA
5 PD12‐00165
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