RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00488
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060831

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Signal Support Specialist) medically separated for chronic back pain.  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 a Medical Evaluation Board (MEB).  The MEB forwarded “lumbago” and “intervertebral disc degeneration” as medically unacceptable to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic back pain…without neurologic abnormality” as unfitting, rated 0% citing criteria of the Veterans Affairs Schedule for Rating Disabilities (VASRD) and with likely application of the US Army Physical Disability Agency policy on rating pain.  The CI made no appeals and was medically separated.  

CI CONTENTION:  “I have been unable to live a normal life since these issues occurred.  Major back pain when trying to be active or doing chores around the house.  Unable to stand or sit for extended periods of time due to pain increase the longer I stand still or sit to long.”  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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting chronic back pain is addressed below.  In addition, the Board will review any neurologic abnormality associated with the CI’s chronic back pain, as directed by the VASRD General Rating Formula for Diseases and Injuries of the Spine.  No additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any condition or contention not requested in this application, or otherwise outside the Board’s defined scope of review, may remain eligible for future consideration by the Board for Correction of Military Records.   The Board acknowledges the CI’s information regarding continued functional impairments associated with his service connected condition.  The military Disability Evaluation System has neither the role nor the authority to compensate service members for post-separation progression 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.    

RATING COMPARISON:  

Informal PEB – Dated 20060524	VA* - (~45 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain…Without Neurologic Abnormality	5299-5242	0%	DDD Lumbar Spine	5242	0%	20100614	
Other x 0 (Not In Scope)	Other x 7	
RATING:  0%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 200100706 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Chronic Back Pain.  The CI had a history of coccyx pain dating back to 1997.  The CI initially sought treatment for lower back pain in 2003.  At a physical therapy evaluation dated 15 December 2004 the CI reported fluctuating lower back pain which increased with activity.  On physical examination there was decreased lumbar lordosis, normal lumbar flexion and extension, and 3-4/10 pain with flexion.  The therapist listed a diagnosis of mechanical low back pain and the CI was referred to back education classes.  A primary care note dated 25 January 2005 noted reports for recurring lower back pain which rarely radiated to the right lower extremity.  The examiner referenced an imaging study which demonstrated disc protrusions at the lower lumbar and lumbosacral levels left nerve root compression.  The CI was treated with physical therapy, chiropractic care, and pain medications.  The narrative summary (NARSUM) examination demonstrated a non-antalgic gait, normal motion, and normal lower extremity motor strength.  At the physical therapy MEB evaluation the CI reported 3/10 lower back pain with intermittent, sharp, shooting pain down the right lower extremity.  The therapy documented that there was pain at the end of motion.  At the VA Compensation and Pension examination performed approximately 45 months after separation, the CI reported mild lower back pain which had not resulted in any incapacitation.  The thoracolumbar spine examination was normal without evidence of spasm, tenderness, or radiating pain.  The goniometric range-of-motion (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.

Thoracolumbar ROM
(Degrees)	FP ~7 Mo. Pre-Sep
	MEB ~4 Mo. Pre-Sep
	VA C&P ~45 Mo. Post-Sep
	
Flexion (90 Normal)	FROM	105,110,110	90	
Extension (30)	FROM	20,20,20	30	
R Lat Flexion (30)	FROM	20,20,20	30	
L Lat Flexion (30)	FROM	20,25,25	30	
R Rotation (30)	FROM	40,35,35	30	
L Rotation (30)	FROM	60,60,60	30	
Combined (240)	n/a	265/270/270	240	
§4.71a Rating	10%	10%	10%	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB and VA rated the chronic low back pain condition at 0%, coded 5299-5242 (degenerative arthritis of the spine).  The Board considered whether the evidence supported a higher than 0% rating.  There was evidence of intermittent localized tenderness not resulting in abnormal gait or abnormal spinal contour or compensable thoracolumbar limitation of motion as well as painful motion on objective exam for a 10% rating.  There is no evidence of an unfitting radiculopathy for an additional disability rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the chronic low back pain 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 lower back pain condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5242 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

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

CONDITION	VASRD CODE	RATING	
Chronic Back Pain 	5299-5242	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140121, 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, AR20160000225 (PD201400488)

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 10% 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:

CF: 
(  ) DoD PDBR
(  ) DVA