RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01870
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050921

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6 (Armor Crewman) medically separated for a back condition.  The back could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “degenerative disc disease,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB forwarded Gastroesophageal reflux disease; intermittent sinus/tension headaches; congenital, bilateral, rigid pes planus; bilateral plantar fasciitis; and primary insomnia), all meeting retention standards, for PEB adjudication.  Informal PEB adjudicated chronic back pain as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be not unfitting.  The CI appealed to the US Army Physical Disability Agency who affirmed the PEB’s findings and rating.  The CI made no further appeal and was medically separated.

CI CONTENTION:  The CI contends only for his unfitting back condition. The applicant’s complete submission is at Exhibit A.  

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 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: 

IPEB - Dated 20050715	VA* - (~17 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5299-5242	10%	Mechanical Low Back Pain	5237	10%	20070220	
Other MEB/PEB Conditions x 5 (Not In Scope)	Other x 12	
RATING:  10%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20070507 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Chronic Back Pain.  The MEB narrative summary (NARSUM) documented a history of non-traumatic chronic low back pain (LBP) dating back to 1987.   Records show that the CI was on active duty from 1985 to 1991 and in 1986 while stationed in Kansas, the CI was working on a tank when he felt pain in his back.  He was seen in the emergency room and diagnosed with myofascial strain and was prescribed anti-inflammatory medication.  Neurosurgery consultation on 2 September 2004 documented a 10-year history of LBP radiating to the left hip region without radiation to the left lower back or legs and no report of numbness or tingling in the lower extremities.  The CI reported his pain in aggravated by lifting and bending and is somewhat relieved by applying heat.  Physical examination recorded normal muscle strength of all major muscle groups, stable gait, and good vascularization of the lower extremities.  The surgeon opined that the CI was not a surgical candidate.  The CI was referred to the pain clinic for monitoring of his back pain.  Magnetic resonance imaging (MRI) of the lumbar spine in October 2003 revealed a broad based, mild disc bulge at L4-L5 level, without significant narrowing of the neural foramen, and a small posterior and lateral disc herniation noted at L5-S1 with narrowing of the right neural foramen.  A second MRI in October 2004 showed a small disc protrusion on the right at L5-S1, but no encroachment upon the nerve roots.  Due to the CI’s symptoms of radiating pain into his right hip, he underwent nerve conduction studies and electromyogram.  The results of the studies were normal.  In addition to consultation with surgery and pain medicine, the CI participated in back school and physical therapy.  He took non-steroidal anti-inflammatory medication as needed and an anti-depressant twice a day for his pain.  During the MEB NARSUM physical examination, performed 5 months prior to separation, a stable non-antalgic gait was noted.  Thoracolumbar spine range-of-motion (ROM) recorded forward flexion of 90 degrees (normal 90) with 30 degrees of extension (normal 30) and a combined ROM of 240 (normal 240).   Mild tenderness to palpation in the L5-S1 area was noted and muscle spasms were absent.  The examiner opined the chronic low back pain and lumbar degenerative disc disease conditions were stable, and the CI should continue with conservative management consisting of medication, activity modification, and home physical therapy.

The VA Compensation and Pension (C&P) exam was accomplished 18 months post-separation and documented moderate pain radiating to right hip and leg that occurs 2 to 3 times a week.  His pain increases with lifting and bending and is relieved with heating pad, icy hot and Motrin.  Examination of the back recorded ROM flexion to 90 degrees and extension to 30 degrees, with pain noted during ROM flexion and extension.

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the condition 10% for pain coded analogously 5299-5242 (Degenerative arthritis).  A higher rating under any of the general spine codes (5235 to 5242) require a ROM limitation of forward flexion of 60 degrees or less, or the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or incapacitating episodes of at least two weeks duration secondary to intervertebral disc syndrome.  Additionally, there was insufficient evidence of a clinically significant radiculopathy that interfered with performance of military duties.  The Board determined there was no VASRD pathway to a rating higher than 10%.  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 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.  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 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131023, 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 XXXXXXXXXXXXXXXXXXXXX, AR20150018451 (PD201301870)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA