RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01915
BRANCH OF SERVICE:  Army	BOARD DATE:  20150219
Separation Date:  20070801

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, (Food Services Operations) medically separated for chronic low back pain (LBP) without neurologic abnormality.  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 lower back pain (LBP)” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic LBP” as unfitting, rated 20%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions.”

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:

IPEB – Dated 20070608	VA* - Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP, without Neurologic Abnormality	5299-5237	20%	Low Back Spondylosis, L4-L5, with Neural Foraminal Narrowing, Degenerative Changes	5010-5239	20%	STR - No Show	
Other x0	Other x4	
RATING:  20%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20071023 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Chronic LBP, without Neurologic Abnormality.  The CI developed back pain after falling approximately four feet onto his back from a military vehicle in September 2005.  A lumbar spine X-ray showed a mild anterior compression deformity of the L1 vertebral level.  The CI improved enough to deploy with his unit in December 2005.  Once in theater, the CI reported increased back pain secondary to wearing his combat gear.  The CI was seen by Primary Care, for throbbing pain with physical exam findings of point tenderness to paravertebral muscles bilaterally, left greater than right in the L1 to S1 areas, slight spasm and full range-of-motion (ROM) with increased tenderness on flexion and extension.  The examiner diagnosed lumbago and prescribed conservative treatment.  He was seen in Iraq for recurrent back pain and treated with non-steroidal anti-inflammatory drugs, muscle relaxers and given a temporary profile.  He complained of worsening back pain and was evaluated by physical therapy at the Combat Support Hospital and prescribed lumbar stabilization exercises.  The physical therapist placed the CI on a temporary profile with restrictions of weight carrying limited to 25 pounds, no pushups, impact exercises or sit-ups.  The CI fell in the dining facility on 17 June 2006 and developed worsened symptoms.  The CI incurred more back trauma when he fell down six stairs on 2 August 2006 and reported hitting his head and back.  He was evaluated, given a narcotic pain reliever and placed on limited duty.  In August 2006, the CI underwent 2-3 osteopathic manipulation which did not improve the symptoms.  The CI continued to report left sided numbness and weakness which was not supported by physical exam.  The CI was observed by his CO, 1SG as well as his three medical providers at an event on Base to be dancing and jumping.  Based on this observation, the CI was given a PULHES of 111111 with specific documentation on how to do several weight lifting exercises and exercises to strengthen his back, legs and upper body.  He continued to report pain that radiated from, his heels to his cervical spine.  The CI again had an injury to his back when he fell on a patch of ice and developed back pain and muscle spasms.  A lumbar spine magnetic resonance imgaing showed mild spondylosis of the lower lumbar spine.  The Orthopedist documented back pain at the lumbar and midline areas and decreased sensation on the left leg to foot.  The CI was given a permanent L3 profile for chronic mid and LBP and spasms with left leg pain and numbness with restrictions on the profile.  The MEB narrative summary (NARSUM) exam approximately 4 months prior to separation documented intermittent sharp pain in the lower back with intermittent radiation of sharp, stabbing, numbing tingling pain into the left leg with occasional muscle weakness.  The MEB NARSUM physical exam findings are summarized in the chart below.  The CI did not present for his initial VA Compensation and Pension (C&P) which was scheduled for 10 October 2007.  The VA C&P exam approximately 4 months after separation documented muscle spasm, stiffness and constant squeezing, aching, sharp cramping, throbbing pain that radiated down the left leg.  The pain was elicited by physical activity and was relieved by medication.  The CI reported incapacitation episodes as often as three times monthly which would last two to three days.  The CI also reported physician prescribed bed rest with the incapacitations; however there was no documentation in the STR.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the chronic LBP, without neurologic abnormality condition as 5299 analogous to 5237, lumbosacral or cervical strain, and rated at 20%.  The VA coded the low back spondylosis, L4-L5, with neural foraminal narrowing, degenerative changes condition as 5010 with 5239 and rated at 20%.  The VA based their rating on the STR as the CI did not show for his exam on 10 October 2007.  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.”  The CI met the 20% criteria for “Forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees”; and “a muscle spasm or guarding severe enough to result in an abnormal gait.”  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, without neurologic abnormality 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, without neurologic abnormality 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 20140429w/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 XXXXXXXXXXXXXXXXXX, AR20150019015 (PD201401915)

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