RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00228
BRANCH OF SERVICE:  Army	Separation Date:  20080307

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Radar Repairer) medically separated for low back pain (LBP).  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “degenerative disc degeneration,” “lumbago” and “muscle spasms” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated the LBP condition as unfitting, rated 10%, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.  

CI CONTENTION:  “The applicant has asked for consideration of her back condition in her application.  Her 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:  

Admin Corr IPEB – Dated 20080303	VA* - (~2 Mos. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Arthritis of Lumbosacral Spine Confirmed by MRI…	5242	10%	Degenerative Changes of the Lumbar Spine	5242	10%	20071228	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 6 (equals SC, NSC & deferred)	
RATING:  10%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20080508 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Back Condition.  The CI developed LBP with activity in May 2007.  A thoracic spine X-ray performed in May 2007 was normal.  A lumbar spine X-ray done in June 2007 was normal.  Despite conservative treatment of rest and non-steroidal anti-inflammatory drugs and physical therapy (PT), the dull aching intermittently sharp shooting pain and muscle spasms continued.  The lumbar spine magnetic resonance imaging (MRI) studies performed in August and September 2007 demonstrated mild degenerative changes in the lumbosacral spine and a small disc protrusion at L5-S1.   The MEB narrative summary (NARSUM) exam performed approximately 5 months prior to separation, documented reports of continued LBP and muscle spasms that rendered her unable to get out of bed.  The symptoms worsened with running, bending, prolonged standing, sit-ups, and heavy lifting.  She reported muscle spasms treated with a muscle relaxant.  The MEB NARSUM physical exam findings are summarized in the chart below.  The commander’s statement indicated that the CI’s diagnosis of spinal degenerative arthritis necessitated her duties changed to light office duties.  Her duties and responsibilities were severely limited due to her condition and thus reduced her impact on the unit.  

The VA Compensation and Pension (C&P) exam performed approximately 2 months prior to separation, documented continued muscle spasms and chronic LBP.  There were range-of-motion (ROM) evaluations in evidence, with documentation of additional ratable criteria, which the Board weighed in arriving at its rating recommendation; as summarized in the chart below.  

Thoracolumbar ROM
(Degrees)	MEB ~5 Mo. Pre-Sep
	
PT~4 Mo. Pre-Sep
	VA C&P ~2 Mo. Pre-Sep
	
Flexion (90 Normal)	ROM’s done by PT	75, 70, 75	0-90 70-90*	
Extension (30)		25, 25, 25	0-30 20-30*	
R Lat Flexion (30)		25, 30, 30	0-30 15-30*	
L Lat Flexion (30)		25, 25, 25	0-30 (45) 15-45*	
R Rotation (30)		30, 30 30	0-30 (45) 15-45*	
L Rotation (30)		25, 30, 30	0-45	
Combined (240)	-	205	240	
Comment	Paraspinal muscle tenderness; limited ROM; motor/sensory/reflexes nml	Goniometer used; pain limited motion; mid lower lumbar muscle guarding; mild slow gait	Minimal gait limitations; *pain, stiffness; mild spasm;  Deluca neg; will have total functional loss with flexion limited to 70 degrees during flare; motor/sensory/reflexes nml	
§4.71a Rating	10%	20%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the LBP condition as 5242 (Degenerative arthritis of the spine) and rated at 10%.  The VA used the same code and rated at 10%.  The General Rating Formula for Diseases and Injuries of the Spine considers the CI’s pain symptoms “with or without symptoms such as pain (whether or not it radiates), stiffness or aching in the area of the spine affected by residuals of injury or disease.”  The Board adjudicated that the VA exam was closer to separation and therefore had the higher probative value.  Although the VA exam documented mild muscle spasm, this was not severe enough to result in an abnormal gait.  The CI met the 10% rating criteria of “muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour” and “forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees.”  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 LBP-muscle spasm 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 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 20131218 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, AR20160000430 (PD201400228)

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