RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXX	CASE:  PD-2013-01311
BRANCH OF SERVICE:  Army	BOARD DATE:  20150114
SEPARATION DATE:  20041220

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Food Service Specialist) medically separated for lumbar spine Physical Evaluation Board (PEB) conditions.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The lumbar spine condition, characterized as “chronic mechanical low back pain (LBP),” was forwarded to the PEB IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “chronic mechanical low back pain, without neurologic abnormality” as unfitting, rated 10%.  The CI made no appeals and was medically separated.

CI CONTENTION:  “ In desperate need of employment;  however, unable to accept anything that requires labor, standing, or lifting because of disability.  Therefore, struggling to survive especially after GI Bill was out…pes planus – flat feet.” [sic]

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation. 

RATING COMPARISON:

Service IPEB – Dated 20040720	VA - Based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Mechanical Low Back Pain	5237	10%	Degenerative Disk Disease…	5243	0%	STR	
Other x 0  (Not in Scope)	Other x 5 	
Combined: 10%	Combined:  0%	
Derived from VA Rating Decision (VARD) dated 20050809(most proximate to date of separation [DOS]

ANALYSIS SUMMARY:

Chronic Mechanical Low Back Pain, Without Neurologic Abnormality Condition.  Available treatment records documented that the CI presented to primary care on 15 February with a    1-year history of low back and multi-joint pain.  She was evaluated by physical medicine and rehabilitation and diagnosed with muscular LBP.  Computed tomography (CT) and magnetic resonance imaging studies of the low back were normal.  She underwent a course of physical therapy, but continued to report persistent LBP.  An orthopedic evaluation, dated 26 July 2002, noted that there was no indication for surgical intervention.  The CI was deployed to Iraq, but was evacuated on 25 June 2003 due to chronic LBP.  X-rays of the lumbar spine dated 8 July 2003 demonstrated fusion of the 5th lumbar vertebral body on the right and evidence of degenerative disc disease at the lumbosacral level.  The CI underwent a second course of physical therapy, epidural steroid injections, and continued pain medications without relief of her chronic LBP secondary to arthritis (facet arthropathy).  The narrative summary physical examination dated 25 June 2004 was significant for muscular tenderness to palpation bilaterally in lumbar region and severe pes planus.  The examiner rendered a diagnosis of chronic mechanical LBP.  The range-of-motion was normal except for slightly decreased thoracolumbar extension and lateral flexion bilaterally.  The CI did not report for her VA Compensation and Pension examination.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB adjudicated the chronic mechanical LBP as unfitting with a disability rating of 10% coded, 5237 (lumbosacral strain).  The VA rated the LBP condition at 0%, coded 5243 (degenerative disk disease).  The Board considered whether there was evidence for a higher than 10% rating for the LBP condition.  There was no evidence of radiculopathy.  There was no evidence of muscle spasms, abnormal spinal contour, abnormal gait, or limitation of forward flexion between 60-85 degrees for a 20% disability 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 mechanical LBP, without neurologic abnormality condition.  The Board concluded therefore that this condition could not be recommended for additional disability 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 chronic mechanical LBP, without neurologic abnormality 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 20130911, 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 XXXXXXXXXXXXX, AR20150008227 (PD201301311)

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