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AF | PDBR | CY2014 | PD-2014-02283
Original file (PD-2014-02283.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX  CASE: PD-2014-02283
BRANCH OF SERVICE: Army  BOARD DATE: 20140710
SEPARATION DATE: 20090522


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (52D/Power Generator Equipment Repairer) medically separated for chronic low back pain (LBP). The back condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS). His profile allowed for alternate aerobic events to satisfy physical fitness standards. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The LBP condition was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded five other conditions, all meeting retentions standards for PEB adjudication. The Informal PEB adjudicated “chronic low back pain” as unfitting, rated 10%, with application of the VA Schedule for Rating Disabilities (VASRD). The remaining conditions were determined to be not unfitting and therefore not rated. The CI made no appeals and was medically separated.


CI CONTENTION: “Please consider all conditions.”


SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2). It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI. The rating for the unfitting back condition is addressed below. The requested left knee, right knee, tinnitus, elevated blood pressure and claustrophobia conditions, which were determined to be not unfitting by the PEB, are likewise addressed below and, no additional conditions are within the DoDI 6040.44 defined purview of the Board. 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 Board for Correction of Military Records.


RATING COMPARISON :

Service IPEB – Dated 20090409
 VA – STR Used
Condition
 Code Rating Condition Code Rating Exam
Chronic Low Back Pain 5237 10% Lumbosacral Strain 5237 10% STR
Right Knee Pain Not Unfitting Right Knee Pain 5299-5260 NSC STR
Left Knee Pain Not Unfitting Left Knee Pain 5299-5260 NSC STR
Tinnitus Not Unfitting Tinnitus 6260 10% STR
Elevated Blood Pressure Not Unfitting High Blood Pressure 7101 NSC STR
Claustrophobia Not Unfitting No VA Entry
Other x 0 (Not is Scope)
 Other x 2 STR
Rating: 10%
 Combined: 30%
Derived from VA Rating Decision (VA RD ) dated 20 110103 ( most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY: The Board acknowledges the CI’s implied contention for ratings of the various conditions noted above which was determined to be not unfitting by the PEB; and, emphasizes that disability compensation may only be offered for those conditions that cut short the member’s career. Should the Board judge that any contested condition was most likely incompatible with the specific duty requirements; a disability rating IAW the VASRD, and based on the degree of disability evidenced at separation, will be recommended.

Low Back Pain. The CI had in-direct traumatic injury to his low back while lifting heavy equipment. His symptoms consisted of persistent LBP and initial numbness into his left leg. X-rays revealed mild degenerative changes and nerve conduction studies were normal. Surgery was not indicated and conservative treatment of medication, manipulation, physical therapy, epidural and facet injections did not provide long-term back symptom relief; however, his left leg numbness resolved. At the MEB narrative summary examination (8 months prior to separation) the CI reported a constant 5-of-10 pain to his lower back. “He is not able to sit for more than 30 minutes (driving), not able to carry more than 20 pounds for more than 10 to 15 minutes before causing back pain.” The physical examination revealed lumbar tenderness and painful limited motion. There was no VA Compensation and Pension exam performed and subsequent rating adjudication was based upon prior service treatment records and clinical notes. The goniometric range-of-motion (ROM) evaluation in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.
Thoracolumbar ROM
(Degrees)
 PT ~9.5 Mo. Pre-Sep
Flexion (90 Normal)
 35
Combined (240)
 165
Comment
 painful motion
§4.71a Rating
 20%

The Board directs attention to its rating recommendation based on the above evidence. Although the service and VA titled the unfitting back condition differently, they both utilized the same 5237 code (lumbosacral strain) and rated at 10%. Board members agreed that sufficient evidence of painful motion was present to justify the service’s 10% rating IAW VASRD §4.71a; however, the measured ROM of forward flexion of 35 degrees (greater than 30, but not greater than 60 degrees) clearly supported a 20% rating. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the LBP condition.

Other PEB Conditions. The other conditions forwarded by the MEB and adjudicated as not unfitting by the PEB were right and left knee pain, tinnitus, elevated blood pressure and claustrophobia. The Board’s main charge with respect to these conditions is an assessment of the fairness of the PEB’s determination that they were not unfitting. The Board’s threshold for countering Service fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard. An established principle for fitness determinations is that they are performance-based; and, the Board is confronted in this case with the lack of any evidence that the limitations imposed by any of the listed conditions prohibited the performance of the duties required of his MOS. None of these conditions were profiled, implicated in the commander’s statement or noted as failing retention standards. All were reviewed and considered by the Board. All evidence considered, there is not reasonable doubt in the CI’s favor supporting re-characterization of the PEB’s fitness adjudication for any of the above stated conditions.


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 LBP condition, the Board unanimously recommends a disability rating of 20%, coded 5237 IAW VASRD §4.71a. In the matter of the right and left knee pain, tinnitus, elevated blood pressure and claustrophobia conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting. There were no other conditions within the Board’s scope of review for consideration.


RECOMMENDATION: The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

UNFITTING CONDITION
 VASRD CODE RATING
Chronic Low Back Pain 5237 20%
RATING
 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20140514, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record









                 
XXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review
SAMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557


 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXX , AR20150006385 (PD201402283)
         

1. 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 to modify the individual’s disability rating to 20% without recharacterization of the individual’s separation. This decision is final.

2. I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.

3. I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

Encl                                                  XXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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