RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00424
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070424

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Motor Transport Operator) medically separated for chronic low back pain (LBP).  The back condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty (MOS) or satisfy physical fitness standards.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “vertebral body compression fractures of L1 and L2” and “L5-S1 disk protrusion,” were 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” as unfitting, rated 10%.  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:  

IPEB – Dated 20070411	VA* - (~3 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5235	10%	Vertebral Fracture  L1 and L2 and L5-S1 Disc Protrusion	5235	10%	20070709	
Other MEB/PEB Conditions x 0 (Not in Scope)	Other x 1 	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20071027 (most proximate to date of separation (DOS)).  Original VARD dated 20070725 is missing from the file.

ANALYSIS SUMMARY:  

Chronic Low Back Pain Condition.  The CI was first seen on 23 October 2006 when she reported a 1 week history of right sided LBP.  She had fallen flat on her back, about 8 feet from a rope on a confidence course.  On examination, she was able to get on and off the examination table without difficulty and walked without difficulty.  Her lower back was tender on the right, but the gait and neurological examination were normal.  Squatting increased her right sided pain.  An X-ray showed a compression fracture at L2.  An MRI on 9 November 2006 showed compression fractures at L1 and L2 as well as a disc protrusion at L5-S1.  A repeat X-ray on 12 December 2006 showed progression of the L1 fracture (acute fractures become more apparent over time [weeks to months] as bone remodeling takes place during healing).  An X-ray on 8 January 2007 showed stable compression fractures at L1 and L2.  However, slight progression at L1 was again seen on 1 February 2007.  The CI had been placed in physical therapy, but was discharged for failure to progress on 23 February 2007.  A final X-ray on 12 March 2007 showed some progression of L2 compared to the prior X-rays in December.  The narrative summary (NARSUM) was dated 13 March 2007, a month prior to separation.  The CI reported continued pain with activity.  On examination, she was noted to have full range-of-motion (ROM) with pain in all planes to the right.  Her gait, posture, and neurological examination were normal.  At the VA Compensation and Pension (C&P) General examination performed on 9 July 2007, 3 months after separation, the CI reported chronic back pain and that walking over 100 yards was difficult.  She did not use an assistive device and could complete the activities of daily living without assistance.  On examination, she walked slowly and with a slight limp.  She was tender over the spine and adjacent muscles.  The ROM was difficult to assess due to pain and limited as charted below.  Repetition was not possible due to pain.  The neurological examination was abnormal with reduced strength in each leg at 4/5, abnormal sensation without specification, and a positive provocative test for nerve root irritation bilaterally.  The CI was seen the next day by a neurologist for a headache evaluation.  Her gait and neurological examination were normal.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the back condition at 10%, coded 5235 (vertebral fracture or dislocation).  While the VA C&P examination supports a 40% rating, it is not consistent with the examination in neurology the next day or with the remainder of the clinical record.  The probative value of this examination is reduced and it was not used for rating purposes.  The MEB examination supports a 10% rating for painful motion.  No route to a higher rating was found.  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 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 chronic low 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 20140114, 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 XXXXXXXXXXXXXXXXXX, AR20160003371 (PD201400424)

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