RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2013-00055
BRANCH OF SERVICE:  Army	BOARD DATE:  20140429
SEPARATION DATE:  20080822

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (92M/Mortuary Affairs Specialist) medically separated for a chronic low back condition.  The condition could not be adequately rehabilitated 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 chronic low back condition, characterized as “chronic low back pain, EPTS with service aggravation” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB forwarded no other conditions to the PEB.  The Informal PEB adjudicated “chronic low back pain” as unfitting and rated it at 10%.  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI elaborated no specific contention in his application.

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 chronic low back condition is 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 20080624	VA - (50 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5242	10%	Degenerative Disk Disease of the Lumbar Spine	5242	10%	20121024	
No Additional MEB/PEB Entries	Other x 5	20121024	
Combined:  10%	Combined: 40%*	
Derived from VA Rating Decision (VARD) dated 20120226 (most proximate to date of separation [DOS]).
* Combined disability rating was 20% from 20080823 then 40% from 20120327 (lumbar spine rating remained 10%).

ANALYSIS SUMMARY:

Chronic Low Back Pain Condition.  The service treatment records show a history of chronic low back pain (LBP) since falling 7 feet from an obstacle during war transition training in April 2007.  X-rays of the lumbar spine, in August and November 2007, showed no evidence of an acute injury (fracture, dislocation).  They demonstrated congenital change at the L5–S1 junction (partial sacralization of L5; incomplete segmentation during development), with a large L5 transverse process making contact with the sacrum on the left (can be a cause for pain).  Magnetic resonance imaging, in November 2007, showed minimal degenerative disc disease with a possible internal disc disruption between lumbar segment five and sacral segment one.  There was no evidence of disc herniation, central stenosis or lateral stenosis.  The physical profile on 11 March 2008 (L3), advised limitation from strenuous military activities (including moving with fight load 2 miles, constructing an individual fighting position, rushes under direct or indirect fire, marching, fitness test, etc.) and lifting more than 20 pounds.  The MEB narrative summary examination dated 11 March 2008 documented chronic LBP not responsive to conservative therapy.  The CI reported that pain was exacerbated to 9/10 pain with physical training (running, push-ups, etc.), lifting and load bearing.  He denied a history of lower extremity numbness, tingling or weakness.  On examination, the CI demonstrated normal posture, gait, muscle strength and reflexes. The visual examination of the spine revealed normal motion, contour (thoracic and lumbar curvature) and showed no back spasms or scoliosis.  Palpation demonstrated left paraspinal muscles tenderness.  Dynamic testing revealed bilateral sacroiliac joint pain with forward flexion.  Straight leg raise exhibited tight hamstrings with distal hamstring pain and tenderness (but no signs of radiculopathy).  The 13 June 2008 physical therapy MEB examination documented completely normal thoracolumbar active range-of-motion (ROM) measurements: flexion 90 degrees (normal 90), extension 30 degrees (normal 30), right and left lateral bending 30 degrees (normal 30) and right and left rotation 30 degrees (normal 30).  There was no decrease in ROM after repetitive movement.  No muscle spasm, altered contour or abnormal gait was reported.  The physical therapist recorded reports of back pain occurring once per day lasting 2 hours and interfering with work.  The commander's evaluation letter on 4 April 2008, cited that because of his medical condition and the duty limiting profile, the CI was unable to perform the duties required by his primary MOS, basic duties of a Soldier, or deployments.  The first post-separation VA examination in evidence was performed on 24 October 2012, 4 years after separation.  Thoracolumbar flexion was 75 degrees with a combined ROM of 225 degrees.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated the unfitting chronic LBP 10% (coded 5242, degenerative arthritis of the spine) with application of the VASRD general rating formula for diseases and injuries of the spine.  The VA rated the back condition 10% based on the VA C&P examination 4 years after separation.  The Board noted that the VA C&P examination carried little probative value for rating the condition at the time of separation due to the long elapsed period of time.  The ROM at the time of the MEB examination was completely normal and did not attain a minimum rating; however there was tenderness and functional loss supportive of the 10% rating adjudicated by the PEB.  There was no muscle spasm causing altered gait or spinal contour to support consideration of a 20% rating.  There was no peripheral nerve involvement due to disc disease for consideration of a separately unfitting rating.  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 chronic LBP 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.  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 chronic LBP 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130131, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		

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 XXXXXXXXXXXXXXXXXX, AR20140020588 (PD201300055)

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