RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-01101
BRANCH OF SERVICE:  Army	BOARD DATE:  20150204
SEPARATION DATE:  20070113

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6 (Automated Logistical) medically separated for chronic low back pain (LBP).  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “herniated lumbar disc,” “facet joint arthritis” and “back pain, degenerative spondylosis” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded two other conditions (hallux valgus and pes planus deformities and major depressive disorder) for PEB adjudication as medically acceptable.  The Informal PEB adjudicated “chronic low back pain” as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be not unfitting.  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI elaborates no specific contentions.  Her 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 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 20061019	VA* - (~5 Mos. Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5243	10%	Herniated Disc at L4-5, w/Lumbar DDD w/Right Lumbar Radiculopathy	5237	0%	20070627	
Other x 2 (Not In Scope)	Other x 12	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20070730 (most proximate to date of separation (DOS)).
ANALYSIS SUMMARY:

Chronic Low Back Pain Condition.  The CI was first seen for LBP in 1998 when she reported a month’s history of pain following the wear of combat gear without other trauma.  She was managed with medications and duty restrictions.  She next presented in 2003 reporting an 8-year history of LBP.  She was treated with physical therapy (PT) and again was able to return to duty.  In 2005, she again reported chronic LBP and was noted to have scoliosis (an abnormal curvature of the spine) on X-ray and treated with both PT and chiropractic therapy without benefit.  Magnetic resonance imaging (MRI) on 31 January 2005 showed degenerative disc disease and degenerative joint disease of the lumbar spine with a herniated disc at L4-5 which compressed the right L5 nerve root.  An MRI of the thoracic spine was remarkable for the previously noted scoliosis.  Over the course of the next year, she was treated with continued physical and chiropractic therapy, medications, injections, and duty limitations without resolution of her symptoms.  She was then issued an L3 profile and entered into the MEB process.

At the MEB examination on 6 January 2006, the CI reported ongoing pain and the use of a back brace.  The MEB physical examiner noted a normal gait and neurological examination without limitation in the range-of-motion (ROM).  Extension was painful and the muscles along the spine tender to palpation.  Notes in PT on 28 February 2006 and on 15 March 2006 noted normal gait, posture, and ROM.  The narrative summary (NARSUM) was dated 20 July 2006, almost 6 months prior to separation.  The CI reported LBP since an injury in physical training in 1996 which persisted despite treatment.  The neurological examination was normal and there was no muscle atrophy.  The gait was not recorded.  Spasm was not recorded.  Provocative testing for nerve root irritation was negative.  The NARSUM referenced normal PT ROMs which are charted below.

At the VA Compensation and Pension (C&P) examination performed 6 months after separation, the CI reported unlimited walking, but that she was careful lifting heavy objects.  Her posture and gait were described as adequate.  The ROM was normal and painless, and is charted below.  Repetitive motion did not cause additional limitation.  There was no spasm.  The neurological examination was normal.

The goniometric 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)	PT ~5 Mo. Pre-Sep
	VA C&P ~6 Mo. Post-Sep
	
Flexion (90 Normal)	90	90	
Combined (240)	240	240	
Comment	Pain not recorded	No pain with motion	
§4.71a Rating	0%	0%	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the back condition at 10% using the 5243 code (intervertebral disc syndrome).  The VA rated the back at 0% using the code 5237 (lumbosacral strain).  The VA later increased the rating to 20%, retroactive to separation, based on a C&P examination over 12 months after separation, since the CI had submitted a claim within 12 months of separation.  The Board considered the evidence.  The ROM values in evidence proximate to separation support a 0% rating.  Absent an abnormal gait or contour due to spasm, incapacitation, painful motion, or ankylosis, the Board found no route to a higher rating than the 10% rating adjudicated by the PEB.  The Board also noted that the VA subsequently rated the CI for a radiculopathy, but found no evidence that an unfitting radiculopathy was present at separation.  The Board concluded therefore that this condition could not be recommended for additional disability rating.  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 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 20140214, 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 XXXXXXXXXXXXXXX, AR20150009940 (PD201401101)

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:

Encl		
						         
CF: 
(  ) DoD PDBR
(  ) DVA