RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX		CASE: PD-2014-00626 
BRANCH OF SERVICE:  Army		separation DATE:  20050816

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Food Service Specialist, medically separated for chronic non-radiating low back pain, rated at 10%.

CI CONTENTION:  The CI elaborated no specific contention in her application. The applicants complete submission is at Exhibit A. 

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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 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:  

SERVICE PEB 20050705	VARD 20081022 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Non-Radiating Low Back Pain	5299-5237	10%	Early Degenerative Changes, Lumbar Spine, L5-S1	5242	10%	20080730	
COMBINED RATING:  10%	COMBINED RATING FOR ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Chronic Non-Radiating Low Back Pain Condition.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic non-radiating low back pain condition began in January 2004 after a lumbar puncture (LP) diagnostic procedure for viral meningitis.  Subsequent radiologic evaluation for persistent low back pain showed only early degenerative changes at the L5-S1 vertebrae, but without resulting spinal canal or neuroforaminal narrowing.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to meet the physical requirements of the CI’s military occupational specialty and she was referred for an MEB.

At the MEB examination (recorded on DD Forms 2807 and 2808) approximately 3 months prior to separation, the CI reported constant back pain.  Physical exam showed painful motion “with forward bending to 90 degrees.”

At an orthopedic specialty evaluation for the MEB on 08 June 2005 (2 months prior to separation), the CI reported she couldn’t walk for more than 10 minutes comfortably and could not lift or stand comfortably.  She denied any radicular pain, or recurrent or persistent lower extremity neurologic symptoms.  Physical exam revealed normal heel and toe walking and no back tenderness.  There was some low pain during resisted hip flexion.  Flexion of the back brought fingertips to the mid-tibia.  Other motion parameters were “entirely normal.”  Lower extremity neurologic findings were normal.

The MEB NARSUM evaluation on 21 June 2005 noted complaints of daily low back pain.  Physical examination showed back flexion of 70 degrees after 3 repetitions (normal 90 degrees) and combined range-of-motion (ROM) of 185 degrees (normal 240 degrees).

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the low back pain condition 10% analogously coded to 5237 (lumbosacral strain), citing forward flexion as the rating rationale.  The VA also rated the condition 10% coded 5242 (degenerative arthritis of the spine), but based on an examination 3 years after separation which was not probative to the time of separation.  The Board agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) and combined ROM (greater than 120 degrees but not greater than 235 degrees) reported on the MEB NARSUM exam.  There was no evidence of muscle spasm or guarding severe enough to result in abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no documentation of incapacitating episodes, which would provide for a higher rating under the alternate VASRD formula for intervertebral disc syndrome, or evidence of ratable peripheral nerve impairment which would provide for additional rating.  

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 chronic low back pain condition.  

BOARD FINDINGS:  In the matter of the chronic non-radiating 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.  

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 20140124, with attachments
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, AR20160005582 (PD201400626)

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