RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-01997
BRANCH OF SERVICE:  Army	BOARD DATE:  20150227
SEPARATION DATE:  20050124

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Unit Supply Specialist) medically separated for low back pain (LBP).  This condition could not be adequately rehabilitated to meet the requirements of her Military Occupational Specialty (MOS).  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The condition “lumbar spine: degenerative disc disease” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded two other conditions (plantar fasciitis and retropatellar pain syndrome, both of which met retention standards) for PEB adjudication.  The Informal PEB adjudicated “chronic non-radiating low 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 made no appeals and was medically separated.

CI CONTENTION:  The CI elaborated no specific contention in her 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 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:

PEB – Dated 20041223	VA* - (~1 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic…Low Back Pain…	5299-5237	10%	DDD at L4-S1	5242	10%	20050225	
Other x 2 (Not In Scope)	Other x 7	
RATING:  10%	RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20050519 (most proximate to date of separation (DOS)).

ANALYSIS SUMMARY:

Low Back Condition.  The CI had a 4-month history of progressive intermittent pain of the lower back that increased with physical activity leading up to 6 December 2002.  At that time, she had an X-ray series of the lumbar spine, which was normal.  Examination revealed a full range-of-motion (ROM) and no muscle spasm.  On 1 October 2003, the CI, who “lifts heavy objects all day,” had 3-to-4 days of LBP, described as a “steady ache” and “sharp” when moving.  Her ROM was “good”; and treatment consisted of a nonsteroidal anti-inflammatory medication prior to and after work.  On 3 June 2004 she was evaluated for recurrent lower back pain with paresthesias to the right buttock and posterior leg, without bowel or bladder symptoms, that occurred after standing for a prolonged period.  Examination revealed a full ROM with tenderness to palpation (TTP) over the right paraspinal area.  Physical therapy (PT) evaluation on 7 June 2004 noted a full ROM and an unremarkable examination; and “CORE” program therapy was instituted.  Upon returning from deployment in August 2003, the CI sought care for a 3-month history of worsening of her back condition, which was not helped with muscle relaxant and nonsteroidal anti-inflammatory medications.  An X-ray series of lumbosacral spine was normal on 4 August 2003; and, a PT examination noted a normal gait pattern, full ROMs without end-range pain, and moderate muscle tension in the paraspinal groups from the lower thoracic to sacral area.  Lumbar stabilization and stretching exercises were instituted.  A magnetic resonance imaging (MRI) on 5 August 2004 revealed mild lumbar scoliosis, an L5-S1 broad-based disk bulge, disk desiccation, mild to moderate facet arthropathy, and a ganglion cyst within the soft tissues.  Chiropractic treatment was instituted on 26 August 2004; and a PT evaluation was carried out 5 days later.  Both found the ROM for flexion to be normal.  Very mild scoliosis at a moderately acute lumbosacral angle was noted on a lumbar spine X-ray series on 31 August 2004.  An orthopedic surgeon noted the CI had some relief with chiropractic treatment, discussed options, and decided to proceed with an MEB.  A permanent L3 profile was issued for LBP on 28 September 2004 with limitations of no running, repetitive jumping, bending, lifting greater than 40 pounds, performing functional military activities, or physical training testing.

At the MEB examination dated 29 September 2004, the CI reported LBP and “was told she has arthritis in her back.”  She said “she was depressed due to her back problem and once she had a referral for MEB there was no need to see anyone.”  The MEB physical examination performed on 18 October 2004 noted TTP at the lumbosacral junction without spasm or deformity and with normal reflexes of the lower extremities.  The commander’s statement dated 12 October 2004 indicated the CI was unable to do most of the work of her MOS that required heavy lifting and staying on her feet for long periods of time.  While she came to work and made an effort to accomplish her duties, she fell short of dong the work done by her peers.  A MEB Consultation performed by an orthopedic surgeon on 13 October 2004 reported the CI’s history of LBP for over a year in the absence of a specific injury or trauma, but after doing a lot of lifting.  PT and home exercise afforded no significant improvement, while chiropractic care did offer some relief.  The pain was well localized to her low back except for one episode of radiation into the lower extremities.  Her gait was nonantalgic and she was able to toe and heel walk.  Active ROM “was hands to her toes, and up with slight knee flexion; good lateral bending, rotation, and extension without pain.”  Neurologic examination was unremarkable.  As a result of the LBP she was unable to adequately perform her MOS duties in supply and had problems with repetitive lifting, impact, or bending over.  The narrative summary (NARSUM) dated 8 December 2004 noted the CI had occasional LBP that started during advanced individual training, which did not require medical treatment.  Worsening of the pain was related to deployment preparation that required heavy lifting.  PT therapy prior to and after deployment did not relieve the pain; and a MRI in August 2004 showed a broad based disc bulge at L5-S1.  Chiropractic treatments afforded temporary relief, but a temporary profile and additional PT did not provide any improvement.  At the time of the NARSUM she had constant LBP, which was maximal on the right side and was aggravated by bending, lifting, twisting, walking more than 15 minutes, and any type of impact activities.  ROMs were flexion 0-80 degrees, backward flexion (extension) 0-25 degrees, left and right lateral flexion 0-25 degrees each, left lateral rotation 0-40 degrees, and right lateral rotation 0-40 degrees.  The ROMs were pain free except for lateral flexion and lateral rotation.  There was no muscle spasm or guarding.  Neurological examination was unremarkable.  The CI was, therefore, limited to light duty in the supply room and was unable to perform the continued weight-bearing and heavy lifting required of her MOS.

A post-separation examination by a Physical Medicine and Rehabilitation specialist on 25 February 2005 noted the CI appeared depressed, had flexion of 80 degrees and extension of 10 degrees with excessive lumbar lordosis and tenderness in the lumbar paraspinal muscles bilaterally.  There was also tightness of select muscles of the hip and thigh, negative straight leg testing (to evaluate nerve root irritation), and an unremarkable neurologic examination.  At the VA Compensation and Pension examination, also dated 25 February 2005, performed a month after separation, the CI reported LBP, without radiation, of approximately a year’s duration related to heavy lifting.  ROMs were normal with pain at the end of all positions except right lateral rotation; and there was no loss of motion with repetition.  Bilateral lumbosacral paraspinal muscles were tender, but there was no muscle spasm.  Exaggerated lumbar lordosis was noted and the neurological examination was unremarkable.

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating using code 5299-5237 (lumbosacral strain) for chronic non-radiating LBP with a forward flexion of 80 degrees.  The VA also assigned a 10% rating using code 5242 (degenerative arthritis of the spine) for degenerative disc disease at L4/S1.  The Board sought a route to a higher rating, which was not available based on her ROMs nor did she have muscle spasm or guarding severe enough to result in an abnormal gait.  However, she did have an X-ray and MRI confirmed very mild lumbar scoliosis and examinations that reported excessive lordosis and an exaggerated lordosis.  The Board members discussed the aforementioned findings, but agreed that presence of scoliosis and/or the exaggerated lordosis in the absence of muscle spasm or guarding did not satisfy a 20% rating.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the low back 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 low back 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 20131024, 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, AR20150011192 (PD201301997)

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