RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2014-00318
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060427

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E-4 (Information Systems Analyst) medically separated for low back pain (LBP).  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for an Medical Evaluation Board (MEB).  Chronic low back pain, severe, was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated chronic low back pain, noting L4/L5 degenerative disc disease with central herniated nucleus pulposus as unfitting, rated 10% with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  He listed the following conditions:  “herniated disk, ankle, back pain, social anxiety, insomnia, severe sleep apnea.”  His 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 condition outside the Board’s defined scope of review (such as the additional ankle, social anxiety, insomnia and sleep apnea conditions cited in the contention) and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military 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 Correction IPEB – Dated 20060320	VA* - (~3 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP…	5237	10%	HNP of the Lumbar Spine…	5243	10%	20060714	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 5	
RATING:  10%	RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20070305 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:  

Low Back Pain (LBP).  The first record in evidence for the LBP is an emergency room note dated 26 May 2005 when the CI reported LBP without antecedent trauma.  He was seen in primary care on 13 June 2005 and noted to have a normal gait and range-of-motion (ROM).  He was again seen on 24 June 2005 in primary care and on 15 June 2005 in chiropractic therapy and retained normal ROM at both examinations.  An MRI on 28 October 2005 revealed a herniated disc (HNP) at L4-5.  A neurosurgical examination on 8 December 2005 noted a normal gait and neurological examination.  The surgeon commented “lumbosacral spine exhibited no abnormalities” implying normal or near normal ROM.  Surgery was not thought to be indicated.  A physical therapy (PT) evaluation on 6 January 2006 noted that the flexion was 75 degrees with normal gait but global tenderness to palpation (back).  The CI was again seen in PT on 30 January 2006 after a TENS (transcutaneous electrical nerve stimulation, for pain) trial which was successful.  The CI was noted to rise quickly and without difficulty from a sitting position when called.  Formal ROM measurements were obtained in PT on 13 February 2006 and are charted below.

The MEB narrative summary (NARSUM) notes was dictated 2 days later and noted that the CI complained of chronic LBP with spasms and radiation of the tingling to the posterior thigh.  Incapacitation was not recorded nor was it found in a review of the records.  On examination, the CI had mild paraspinal tenderness.  The neurological examination was normal and atrophy not recorded.  The ROM was reduced as charted below (from the above cited PT measurements).

At the VA Compensation and Pension (C&P) examination performed on 14 July 2006, 3 months after separation, the CI reported ongoing pain, but that he could function without medications and was able to push a lawnmower.  Incapacitation was not recorded.  On examination, his posture and gait were normal and he did not use an assistive device.  The ROM was full, but painful; repetition did not cause a further limitation.  He was thought to have a sensory loss in the L5 distribution bilaterally.  This was not previously recorded.  The motor examination was normal.  The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.
DOS 20060427
Thoracolumbar ROM
(Degrees)	Neurological
~5 Mo. Pre-sep	PT
~3 Mo. Pre-Sep	MEB
PT ~2 Mo. Pre-Sep	VA C&P
~3 Mo. Post-Sep	
Flexion (90 Normal)	~90	75	50 (50 52 48)	90	
Combined (240)	--	--	145	240	
Comment	Normal gait and neurological examination; painful motion not cited	Gait normal; global TTP (back); painful motion not cited	Paraspinal tenderness; limited by pain	Painful motion	
§4.71a Rating	0%	0/10%	20%	10% (4.59)	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the back at 10%, coded 5237 (Lumbosacral strain) and 5243 (Intervertebral disc syndrome), respectively.  The Board considered the evidence.  While the ROM measurements obtained for the MEB support a 20% rating, these are inconsistent with multiple other examinations which showed normal or near normal ROM.  The Board found no other evidence to support a rating higher than the 10% adjudicated by the PEB.  The VA did note a radiculopathy in the L5 distribution bilaterally.  This was not previously noted.  The evidence does not support the addition of an unfitting radiculopathy at separation.  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 fitness determination 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.  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 pain 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 20131230, 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 XXXXXXXXXXXXXXXXXXXXXX, AR20160000181 (PD201400318)

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