RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-01737
BRANCH OF SERVICE:  Army	BOARD DATE:  20141217
Separation Date:  20080811

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Forklift Driver) medically separated for chronic low back pain (LBP).  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The chronic LBP condition, characterized as “chronic lower back pain” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “chronic LBP” as unfitting rated 20% citing criteria of VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Consider all conditions found unfitting by the physical evaluation board.”  

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:

Service IPEB – Dated 20080416	VA - Based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP	5237	20%	Lower Back Injury	5299-5239	Non Service Connected (NSC)*	STR/No Show	
Other x0	No VA Conditions Noted	
Combined:  20%	Combined:  NSC	
Derived from VA Rating Decision (VARD) dated 20090713 (most proximate to date of separation [DOS])
*A VA compensation & Pension (C&P) exam was performed 20100108; VARD dated 20100216 also denied service connection

ANALYSIS SUMMARY:  

Chronic LBP Condition.  The CI developed a sudden onset of LBP in February 2006 as a result of doing a lot of lifting and carrying.  A lumbar spine X-ray showed possible L5 spondylosis.  A repeat lumbar spine X-ray with oblique views showed a definite right L5 spondylosis and a left L5 defect that could represent a partial or complete spondylosis.  The CI was evaluated by a physical therapist for a series of intense therapy to reduce the LBP.  The orthopedist documented physical exam findings of diffuse tenderness to palpation in the lumbar region with decreased range-of-motion (ROM) throughout.  The CI was given a lumbar support wrap to wear during the daytime along with a temporary L2 profile for spondylosis of the lumbar spine.  A lumbar spine magnetic resonance imaging demonstrated degenerative disc disease at L5-S1.  The neurosurgeon noted that the CI reported muscle spasms; however, the physical exam was normal and he concluded that no surgery was required.  The Pain Management Specialist noted the CI reported worsening of pain with most activities, prolonged standing as well as stationary bike.  The physical exam findings were tenderness of the paraspinal region with abnormal heel walking.  The examiner administered an epidural steroid injection at this visit.  The MEB narrative summary (NARSUM) exam approximately 5 months prior to separation documented constant sharp lower back pain, which was worse on the right and radiated into his buttocks that was variable with a pain rating of 3/10 at baseline up to 8/10 with certain movements and stretching maneuvers.  The CI also reported occasional numbness in the right and left thigh.  The pain was aggravated by cold weather and improved by sleeping on the hard floor.  The MEB NARSUM physical exam findings were summarized in the chart above.  The VA C&P exam 17 months after separation documented that the CI reported constant aching LBP with a pain rating of 4-5/10 at baseline, which radiated into his buttocks.  He had chronic back stiffness, difficulty bending along with fatigue with a lack of endurance.  The VA C&P physical exam findings were summarized in the chart above.

There were two goniometric ROM evaluations in evidence, with documentation of additional ratable criteria, which the Board weighed in arriving at its rating recommendation; as summarized in the chart below.

Lumbar ROM (Degrees)	MEB 5. Mos. Pre-Sep	VA C&P 17 Mos. Post-Sep	
Flexion (90 Normal)	75	90	
Combined (240)	205	240	
Comment	Pos. painful motion; Normal gait; No spasm or localized tenderness; No motor or sensory deficits	Normal gait & posture; No painful motion; No Deluca criteria; Normal strength, sensory & reflexes	
§4.71a Rating	10% (PEB 20%)	0% (VA NSC)	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the chronic LBP condition as 5237 (lumbosacral or cervical strain) rated at 20%.  The VA coded the lower back injury condition as 5299 analogous to 5239 (spondylolisthesis or segmental instability) and did not grant service-connection.  The VA based their decision on the C&P examiner who determined that the CI had lumbosacral DDD and a bilateral L5 pars defect that was a “congenital anomaly” which was read in the Service as lumbar spondylosis.  The VA concluded that based on this interpretation of the X-ray, that the condition “…was not aggravated beyond normal progression as a result of military service because there were no injuries sufficient to have aggravated his condition.”  The General Rating Formula for Diseases and Injuries of the Spine considers the CI’s pain symptoms “With or without symptoms such as pain (whether or not it radiates), stiffness or aching in the area of the spine affected by residuals of injury or disease.”  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 LBP 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 LBP 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 20140414, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

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 XXXXXXXXXXXXXXX, AR20150009536 (PD201401737)

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						     XXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA