RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-01447
BRANCH OF SERVICE:  Army	BOARD DATE:  20150114
SEPARATION DATE:  20041206

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an reserve 1LT (Signal Officer) medically separated for chronic low back pain (LBP).  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The LBP, characterized as “chronic low back pain” and “degenerative disc disease (DDD),” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “degenerative disc disease with chronic low back pain” as unfitting, rated 10%.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Back injury from IED attack has effected my entire body by damaging my core.  I need constant medication to deal with the pain & life impact, and regularly use alternative treatments like chiropractic & massage.”

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 20041206	VA - (1 Mos. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Disc Disease With Chronic Low Back Pain	5299-5242	10%	Degenerative Disc Disease Lumbosacral Spine, L1-2, L2-3,
With Right Paracentral Disc Protrusion, L5-6	5237-5243	10%	20041027	
Other x 0  (Not in Scope)	Other x 12 	
Combined:  10%	Combined:  40%	
Derived from VA Rating Decision (VARD) dated 20041216 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Degenerative Disc Disease with Chronic Low Back Pain:  The CI sustained a blast injury on 27 September 2003.  On 20 January 2004, the CI presented with reports of sporadic low back and buttock pain since the injury.  Radiographic evaluation dated 4 March 2004 was normal with identification of an anatomical variant at the lumbosacral junction.  The CI was treated with physical therapy and pain medications.  A physical medicine and rehabilitation (PM&R) follow-up consultation dated 14 April 2004 documented activity dependent back tightness.  The physical examination demonstrated right greater than left paraspinal lumbar tenderness to palpation, taut illiotibial bands, and a pain limited thoracolumbar flexion.  The examiner rendered a diagnosis of LBP and noted the potential source as mechanical, muscular (myofascial), or right sacroiliac dysfunction.  The examiner recommended a magnetic resonance imaging (MRI) study, chiropractic care, physical therapy, and narcotic medication.  At a PM&R follow-up dated 26 May 2004 the MRI results were noted to reveal a transitional lumbar-6 vertebra, lumbosacral disc protrusion, multi-level degenerative disc changes, and mild straightening of the lumbar spine.  An electromyogram dated 13 August 2004 was negative for radiculopathy.  The CI continued with chiropractic care, physical therapy, three epidural steroid injections, and narcotic pain medication with intermittent relief of his LBP.  At narrative summary (NARSUM) dated 23 August 2004 the CI reported persistent LBP made worse by wearing military gear, lifting, running, and prolonged walking or standing.  The physical examination demonstrated  a normal gait, lumbosacral paraspinal (right>left) tenderness to palpation with moderate spasms, thoracolumbar flexion limited to 54 degrees, and pain in all planes of thoracolumbar motion.  A diagnosis of chronic LBP with DDD and disc protrusion was rendered.  At the VA Compensation and Pension examination performed a month prior to separation, the CI reported chronic low back stiffness, weakness, and pain.  The pain was rated six on a scale of one to ten and was made worse with physical activity and inclement weather.  He also reported bilateral lower extremity tingling to the knees.  The physical examination revealed lumbar spine and muscle tenderness to palpation, a normal gait, and painful thoracolumbar flexion (90 degrees), extension (20 degrees), and lateral flexion (30 degrees).

The Board directed attention to its rating recommendation based on the above evidence.  The PEB adjudicated the DDD with chronic LBP as unfitting with a disability rating of 10% coded, 5299-5242 (degenerative arthritis of the spine).  The VA rated the LBP condition at 10%, coded 5237-5243 (lumbosacral strain–DDD).  The Board considered whether there was evidence for a higher than 10% rating for the LBP condition.  The Board noted that radiculopathy studies demonstrated no evidence of radiculopathy.  Although treatment notes and the NARSUM demonstrated limitation of flexion to 50-55 degrees, VA examination (a month prior to separation) and treatment records within 12 months of separation demonstrated no evidence of muscle spasms, abnormal spinal contour, abnormal gait, or limitation of forward flexion between 30-60 degrees for a 20% disability rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), Board consensus was that there was insufficient cause to recommend a change in the PEB adjudication for the DDD with chronic LBP condition.  The Board concluded 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 DDD with chronic LBP condition and IAW VASRD §4.71a, the Board 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 20130913, 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 XXXXXXXXXXXXXXX, AR20150008487 (PD201301447)

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