RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxxxxxxxxxxxxxxxxxxxxxx	   CASE:  PD-2014-00680
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050503

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E-3, Military Policeman, medically separated for chronic radiating low back pain.  The 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 “low back pain” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “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 20050314	VA* - (~2 Mos. Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5237	10%	Posttraumatic Lumbar Strain, Degenerative Disk L5/S1 with Sciatica and Facet Arthrosis of L4/5	5237	10%	20050705	
Other x 0 (Not In Scope)	Other x 7 	
RATING:  10%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20051103 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Low Back Condition.  The service treatment record (STR) and narrative summary (NARSUM) documented an injury to the lower back in April 2004 (3 months after entry) during tactical training while manning an automatic weapon in a Humvee.  The CI was evaluated in April, May and July of 2004 (approximately a year pre-separation) and found to have normal alignment and full range-of-motion of the back without pain or radiation.  During a physical therapy evaluation in July 2004 (10 months pre-separation), the examiner documented a normal gait, full range-of-motion (ROM) with “pain at end range,” and normal strength.  The straight leg raise (SLR) nerve tension exam was negative to 80 degrees bilaterally with no complaint of low back pain.  Radiographs of the lumbar spine in August 2004 documented lumbar curvature to the left with normal disc spacing, no evidence of slippage or fracture, and an incidental congenital finding (occult spina bifida).  At a clinic visit in August 2004 (9 months pre-separation), the CI reported back pain radiating to the left foot.  The examiner documented a normal gait and reflexes, full ROM, and dysesthesia (discomfort) of the left foot with SLR.  Magnetic resonance imaging (MRI) in August 2004 documented degenerative joint disease with some narrowing of the L4-L5 nerve canal (“facet arthrosis and mild neural foraminal stenosis”).  During an orthopedic visit in October 2004 (7 months pre-separation), the CI reported frequent bending during work duties exacerbated her symptoms.  The examiner documented a positive SLR on the left and diagnosed “low back pain with radiculopathy.”  On the MEB DD Form 2807-1, Report of Medical History (5 months pre-separation), the CI reported paresthesias of the left leg when bending over or “when in any position for too long.”  On the MEB DD Form 2808 Report of Medical Examination, the examiner documented a normal gait and symmetric reflexes, full range-of-motion in all planes, and no swelling or spasm.  The commander’s statement (dated 14 December 2004) stated limitations regarding physical fitness and that her medical condition caused “pain throughout the duty day” limiting her ability to perform assigned tasks.  Electrophysiologic studies in January 2005 (4 months pre-separation) demonstrated no evidence of a lumbosacral radiculopathy.  There was no STR documentation of thoracolumbar flexion less than 90 degrees; spasm, guarding, or localized tenderness resulting in abnormal gait; and no documentation of physician prescribed bed rest or periods of incapacitation.  

The MEB NARSUM exam was performed on 4 February 2005 (3 months pre-separation).  The CI reported 7-8/10 constant left sided lower back pain that prevented her from bending, squatting, kneeling, wearing protective body armor, carrying a ruck sac with any significant weight, conducting vehicle and body searches, or detaining suspects as required by her MOS.  The examiner documented a symmetric spine without abnormal curvature or deformity, with full range-of-motion; normal strength, sensation, and reflexes; and no complaint of low back pain or radiation with SLR bilaterally.  

At the VA Compensation and Pension (C&P) exam performed on 5 July 2005 (2 months post-separation), the CI reported daily and constant back pain averaging 7/10.  She reported flares to 10/10 occurring approximately 2-3 times a week, lasting 1 to 2 days, with an estimated 45 degree loss of forward flexion.  During flares, she described inability to get out of bed or go to work, however denied any incapacitating episodes in the previous 12 months.  She reported limping “on occasion,” attributed to the radiating low back pain.  She denied any functional problems related to the radiating pain, stating it was “merely annoying.”  The examiner documented a normal gait, a negative nerve tension (SLR) exam, with normal strength and reflexes bilaterally.  Forward flexion of the lumbosacral spine was 85 degrees (normal 90), extension of 40 degrees (normal 30); bilateral lateral rotation and bilateral lateral flexion were normal.  The examiner estimated a 45 degree loss of flexion, and a 10 degree loss of extension and lateral flexion due to flare ups from pain and further stated that there was no loss of ROM due to repetitive use, no excess fatigability, and no weakened movement or in coordination with repetition.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB adjudicated the chronic radiating low back pain as unfitting and gave a rating of 10%, analogously coded 5299-5237 (lumbosacral strain) referencing the USAPDA pain policy for “slight.”  The VA rated 10% coded 5237.  

There was no STR or VA documentation of thoracolumbar flexion less than 60 degrees.  There was no consistent evidence of spasm, guarding, or localized tenderness resulting in abnormal gait or spinal contour in support of a higher rating.  There was no evidence of further loss of range-of-motion on repetition.  There was no documentation of physician prescribed bed rest or periods of incapacitation to support a higher rating under the VASRD codes for intervertebral disc syndrome.  The pain component of a radiculopathy is subsumed under the general spine rating as specified in §4.71a.  Although radiating pain was reported, Members agreed that there was no evidence for a separately ratable functional impairment (with fitness implications) from the radiculopathy; and the Board cannot support a recommendation for an additional disability rating on this basis.  Rating in this case was predominately based on ROM measurements.  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 10% for the low back condition was appropriately recommended in this case.  

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 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 20140124, 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 XXXXXXXXXXXXXXXXXXXXXXX, AR20160003058 (PD201400680)

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