RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01983
BRANCH OF SERVICE:  Army 	BOARD DATE:  20150729
SEPARATION DATE:  20050531

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Administrative Specialist) medically separated for back pain.  The back condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty (MOS).  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “chronic low back pain with evidence of spondylosis and degenerative disc disease of the lumbar spine” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB (IPEB) adjudicated chronic back pain as unfitting, rated 10%.  The CI appealed to the Formal PEB, but withdrew her appeal and was medically separated.  

CI CONTENTION:  The CI requested that the Board review her case to determine if she is entitled to additional benefits. 

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:  

 IPEB – Dated 20050114	VA* – (~6 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5237	10%	Degenerative Disc Disease 	5242-5243	20%	20051123	
Other MEB/PEB Conditions x 0 (Not in Scope)	Other x 8	
RATING:  10%	RATING:  70%	
*Derived from VA Rating Decision (VARD) dated 20060406 (most proximate to date of separation [DOS])  

ANALYSIS SUMMARY: 

Chronic Back Pain.  In 2002, the CI started having problems with low back pain (LBP).  In March 2004, magnetic resonance imaging revealed degenerative disc disease at multiple levels of the lumbar spine.  On 23 April 2004, she was seen by Neurosurgery.  It was decided that she was not a surgical candidate.  The CI’s back pain was treated with physical therapy (PT), epidural steroid injections, lumbar facet blocks, and other non-operative modalities.  In spite of all treatment efforts, her LBP persisted and an MEB was initiated. The MEB narrative summary (NARSUM) was dictated on 14 September 2004.  The CI reported that she was unable to run, jump, or march, and unable to wear load-bearing equipment such as a rucksack.  On physical examination (PE), her gait was “guarded.”  There was increased tone and tenderness in the paralumbar muscles, left greater than right.  Straight leg raise (SLR) was negative bilaterally.  Range-of-motion (ROM) was measured by PT, and is summarized in the chart below.  The NARSUM diagnosis was: “Chronic low back pain with evidence of spondylosis and degenerative disc disease of the lumbar spine.

The CI was medically separated from service in May 2005.  In November 2005, about 6 months later, she had a VA Compensation and Pension (C&P) exam.  She reported that her pain was constant, and sometimes it radiated to the legs.  She said that a flare-up would occur with prolonged standing, prolonged sitting, prolonged bending, or too much walking.  On PE, her gait was non-antalgic.  SLR caused some pain in the lumbosacral spine area.  ROM was measured, and is summarized in the chart below.

Thoracolumbar ROM
(Degrees)	MEB-PT ~ 9 mos. Pre-Sep
(20040818)	VA C&P ~ 6 mos. Post-Sep
(20051123)	
Flexion (90 Normal)	30	40	
Extension (30)	15	15	
R Lat Flexion (30)	10	20	
L Lat Flexion (30)	10	20	
R Rotation (30)	20	15	
L Rotation (30)	25	15	
Combined (240)	110	125	
Comment	Pain with motion	Pain with motion	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and the VA chose different coding and rating options for the LBP condition.  The November 2005 C&P exam was just 6 months after separation, and therefore had significant probative value.  At that exam, thoracolumbar forward flexion was 40 degrees.  IAW the VASRD §4.71a General Rating Formula for Diseases and Injuries of the Spine, a 20% disability rating is warranted when thoracolumbar forward flexion is greater than 30 degrees but not greater than 60 degrees.  The Board determined that a 20% disability rating was appropriate in this case.  

The Board tried to find a path to a higher rating, using other VASRD codes which could be applied to the CI’s back pain condition.  There was no path to a higher rating, because there was insufficient evidence of a severely crippling back condition or spinal abnormality that would justify a higher rating.  The Board also considered the matter of radiculopathy.  After review of all the information in the record, there was insufficient evidence of a clinically significant radiculopathy that interfered with performance of military duties.  The CI did have neurological symptoms.  However, there was not sufficient performance-based evidence that the neurological condition caused significant interference with the satisfactory performance of military duties.  Therefore, the Board concluded that there was no unfitting radiculopathy present at separation.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board unanimously recommends a disability rating of 20% for the 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.  In the matter of the Chronic back pain condition, the Board unanimously recommends a disability rating of 20%, coded 5242, IAW VASRD §4.71a.   There were no other conditions within the Board’s scope of review for consideration.

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

CONDITION	VASRD CODE	RATING	
Chronic back pain 	5242	20%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131025, 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 XXXXXXXXXXXXXXXXXXXX, AR20150015853 (PD201301983)

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						     

CF: 
(  ) DoD PDBR
(  ) DVA