RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00810
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070705

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E3, Military Police, medically separated for “low back pain” with a disability rating of 10%.  

CI CONTENTION:  Her back condition continues to worsen and negatively impact her daily activities.  Her major depression and cyst deserve a higher rating.  The applicant’s 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 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:  

SERVICE PEB - 20070523	VARD – 20071012 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5237	10%	Degenerative Disc Disease, Lumbar Spine	5243	10%	20080811	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM) the CI’s back condition began in September 2006 after the CI, in full combat gear on a confidence course, fell 6 feet, landing on the lower back.  The CI complained of back pain without radiculopathy.  Initial diagnostic imaging was negative for a fracture; however, follow-up imaging in November 2006 showed bulging lumbar discs.  

Evaluation by physical medicine in December 2006 indicated complaints of constant back pain aggravated by activities.  The CI denied radiating pain or numbness.  On examination the gait was non-antalgic and provocative testing for radiculopathy was negative.  There was tenderness to palpation in the lower spine with “trunk flexion to about 70 degrees [normal 90], extension to 5 degrees [normal 30] – appears limited by pain.”  Sensory, motor and reflex examinations were normal.  The examiner concluded with diagnoses of lumbago and bulging intervertebral disc lumbar.  The CI underwent physical therapy without improvement and was given steroid injections by physical medicine in December 2006 and the pain clinic in early 2007, again without improvement.  The CI was not a surgical candidate.  Despite treatment, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “low back pain secondary to herniated disks at L4-5 and L5-S1 and spondylolisthesis of L5 on S1” for PEB adjudication.  

At the NARSUM examination in March 2007, approximately 3 months prior to separation, the CI complained of back pain, but denied pain radiation down the legs or numbness/tingling in the legs.  Physical examination noted normal gait.  Provocative testing for radiculopathy was negative (straight leg raise) and there was normal heel and toe walk.  There was tenderness over the left paraspinous muscles, without muscle spasm.  The examiner stated “there was full range of motion of the lumbar spine with some stiffness and discomfort at end ranges of flexion and extension.”  Reflexes, motor strength and sensation were normal.  

At the VA Compensation and Pension (C&P) examination in August 2008, performed 13 months after separation, the CI reported ongoing symptoms of lower back pain with prolonged standing, sitting, walking, bending and lifting.  Physical examination showed tenderness to palpation, no spasm and no deformity.  The range-of-motion (ROM) was painful with forward flexion to 75 degrees (normal 90) and combined ROM of 205 degrees (normal 240).  There was no weakness, fatigability, lack of endurance or decreased ROM following repetition.  Provocative testing for radiculopathy was negative.  Lower extremity motor, tone, bulk, strength and sensation were intact.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 5237 code (lumbosacral strain) citing tenderness to palpation with no spasm or deformity.  The VA also assigned a 10% rating using the 5243 code (intervertebral disc syndrome) based on the VA C&P examination 13 months after separation, citing ROM criteria. 

The Board agreed that a 10% rating, but no higher, was justified for tenderness to palpation without spasm or deformity reported on the NARSUM examination.  ROM limitations would not rate higher than 10%.  There was no 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 evidence of intervertebral disc syndrome resulting in incapacitating episodes requiring bed rest prescribed by a physician to warrant consideration of rating under the alternate VASRD formula based on incapacitating episodes due to intervertebral disc syndrome.  There was no evidence of an associated unfitting radiculopathy for consideration of a separate peripheral nerve 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 back condition.  

BOARD FINDINGS:  In the matter of the 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.  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 20140213, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXX, AR20160007457 (PD201400810)

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