RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01809
BRANCH OF SERVICE:  Army	 SEPARATION DATE:  20060504

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard E-1, (Infantryman) 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 was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501 as medically unacceptable.  No other conditions were submitted by the MEB.  The Informal PEB (IPEB) adjudicated “chronic low back pain” as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI contends that his pain has become much worse over the years.  His 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 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 20060323	VA - (9 Mo. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5237	10%	Lumbosacral Strain	5237	10%	20061211	
Other x 0 (Not in Scope)	Other x 0		
Combined:  10%	Combined:  10%	
Derived from VA Rating Decision (VARD) dated 20070203 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Chronic Low Back Pain Condition.  The service treatment record documents that the CI sustained a back injury during basic training in 2000.  At the 20 September 2000 Acute Care encounter, the CI complained of 15 days of low LBP which began in the field while carrying his rucksack.  The CI was prescribed an anti-inflammatory and muscle relaxant.  The MEB narrative summary (NARSUM) by Family Medicine was dated 20 December 2005, just over 5 months prior to separation.  Initial therapy was osteopathic manipulative treatment, an anti-inflammatory medication, and a 2-week restricted profile.  The CI was able to complete basic training.  His back pain had resolved at his 2-week follow-up, and he was discharged without restrictions.  The back pain recurred during an 8-mile road march while performing annual training in January 2002.  The CI failed conservative therapy (activity modification, medications, physical therapy, osteopathic manipulative treatment, and chiropractic manipulative treatment).  The chronic back pain was worse in the morning and exacerbated by activity and prolonged standing.  The NARSUM also documented radiological exams which were not otherwise in evidence.  The October 2005 lumbosacral spine X-rays were normal.  A lumbar spine magnetic resonance imaging noted mild degenerative disc disease at T12/L1.  A lumbar spine CT showed broad based disc bulges at L4/L5 and L5/S1 abutting the L5 and S1 nerve roots.  The exam noted mild bilateral paraspinal muscle tenderness from the thoracolumbar junction to the sacrum.  Strength, sensation, and deep tendon reflexes were normal.  The seated straight leg raise (SLR) tests (assesses nerve root compression by a herniated disc by eliciting sciatic nerve pain with the leg between 30 and 70 degrees) were negative.  The supine SLR tests were at the normal cut-off.  Neither gait nor spasm was specifically commented upon.  However, the CI was noted to be in no distress and the exam was “normal,” other than as specifically annotated, implying that the gait was normal and spasm absent.  The lumbosacral spine range-of-motion (ROM) values are summarized in the chart below.  A 27 October 2006 lumbosacral spine X-ray showed a transitional S1 vertebra (normal congenital variant) and possible kidney stone.  In the 4 November 2006 spine VA Compensation and Pension (C&P) exam, 6 months after separation, the CI complained of chronic, daily, stabbing, LBP with associated stiffness, decreased motion, fatigue, and flare-ups.  He denied incapacitating episodes in the last 12 months, numbness, abnormal sensation, radiation, spasms, weakness, unsteadiness, falls, or assistive devices.  Pain was alleviated by stretching.  The CI reported less than a week lost from work during the last 12 months.  Physical exam revealed a normal gait without abnormal spinal curvatures.  The thoracic spine showed tenderness and pain with motion.  There was no muscle spasm, localized tenderness, or guarding severe enough to cause an abnormal gait, atrophy, guarding, or abnormal spinal contours.  Muscle tone was normal and sensation and deep tendon reflexes were intact.  There was pain with motion but no additional loss of motion on repetitive use.  Thoracolumbar spine ROMs are summarized in the chart below.  The gait and neurological exams were again noted to be normal at the general C&P exam five weeks later.

The Board directed attention to its rating recommendation based on the above evidence.  A month prior to separation the IPEB rated the chronic LBP condition at 10% (VASRD code 5299-5237; rating by analogy-lumbosacral or cervical strain).  The PEB cited ROM limited by pain, tenderness to palpation, and no neurological abnormality.  The VA rated the chronic LBP condition at 10% (5237) citing pain with ROM, no muscle spasms, and a normal neurological exam.  The criteria for rating diseases and injuries of the spine apply 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.  Both proximate exams support a 10% rating using VASRD §4.59 (painful motion), as did the ROM on the MEB exam.  Other routes to a higher rating were considered, but there was no evidence of additional functional loss from repetitive use to warrant application of VASRD §4.45; and no evidence of incapacitating episodes that would justify a minimum rating under the alternative formula for rating intervertebral disc 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 (5237).

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 20140425, 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 XXXXXXXXXXXXXX, AR20150018383 (PD201401809)

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