RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01961
BRANCH OF SERVICE:  Army	BOARD DATE:  20150115
SEPARATION DATE:  20060623

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Wheeled Vehicle Mechanic) medically separated for back pain.  This condition could not be adequately rehabilitated to meet the requirements of his Military Occupational Specialty although he was authorized to perform alternate physical fitness testing.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The back condition, characterized as “chronic lower back pain”, 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 back pain…” as unfitting, rated 10%, with likely application of the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please review all medical conditions.”

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:

IPEB – Dated 20060522	VA* - (~6 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain…	5299-5237	10%	Lumbar Spine DDD	5242	0%	20061208	
Other x 0	Other x 3	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20070322 (most proximate to date of separation (DOS))

ANALYSIS SUMMARY:   

Back Pain.  The CI’s history of low back pain (LBP) began in January 2005 after he reportedly injured his back while playing basketball during physical training.  Radiographs of the lumbar spine, January 2005, noted mild scoliosis.  Magnetic resonance imaging of the lumbar spine dated 25 June 2005 demonstrated posterior disk bulging at the lumbosacral junction with mild disk degeneration (L5-S1), and mild degenerative facet disease.  There was minimal diffuse spondylosis and no evidence of disk herniation.  The CI underwent treatment that included physical therapy exercises, chiropractic care, aquatic therapy, pain medications, and a transcutaneous electrical nerve stimulation unit (electrical nerve stimulation).  He had consultation and treatment with physical medicine and was provided injections to relieve his pain.  Treatment was of limited benefit; he continued to have pain.  The CI did not experience any incapacitating episodes; however, having failed conservative treatment he was placed on a permanent profile.  At the MEB/narrative summary exam dated 20 March 2006, approximately 3 months prior to separation, the CI reported he initially experienced persistent back pain for over six months but most recently his pain had become intermittent.  He described his pain as throbbing in nature with occasional symptoms down his left lower extremity.  His pain worsened with prolonged sitting, running, jumping, wearing and carrying military gear, and with bending or twisting activities.  Alleviating factors were not recorded.  The MEB physical exam noted tenderness to palpation over the lumbar paraspinal musculature on the left and noted muscle strength testing was limited by pain, and that the CI reported decreased sensation to light touch along the bottom of the left foot.  The examiner deferred to the range-of-motion (ROM) testing performed by physical therapy dated 28 February 2006, approximately 4 months prior to separation, noted thoracolumbar flexion on three attempts averaged 47 degrees.  Extension was recorded at 15 degrees.

At the VA Compensation and Pension (C&P) dated 8 December 2006, approximately 6 months after separation, the CI reported he was incapacitated for 72 hours in the days following the injury (not recorded in the available evidence).  He reported he had pain, stiffness and weakness in the lumbar spine that at times radiated into the left lower extremity.  His baseline pain was recorded at 2/10 on the scale of 0-10.  He noted his pain was responsive to bed rest, heat and cold packs, and non-steroidal anti-inflammatory over the counter medication.  The CI did not require an assistive device for ambulation and indicated he could walk five miles.  Forward flexion ROM was recorded at 90 degrees (90 normal), and after repetitive motion the back was not additionally limited by pain, fatigue, weakness, lack of endurance or incoordination.  Muscle spasm, guarding, and painful motion were absent, and his gait was normal.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the condition 10% for pain limiting motion with localized tenderness coded analogously 5237 (lumbosacral strain).  The VA rated 0% coded 5242.  The PEB opined the ROM flexion was limited by pain alone.  A higher code of 20% requires spasms producing abnormal gait, or abnormal curvature of the spine, or forward flexion not greater than 60 degrees.  The Board reviewed the record in evidence and noted there were two other recorded ROM entries in the months prior to separation, both were consistent with the last recorded ROM for the MEB.  The ROM recorded on 8 November 2005, 7 months prior to separation, noted forward flexion of 55 degrees and the ROM recorded on 28 February 2006 (4 months prior to separation) with forward flexion of 48 degrees.  The Board is required to evaluate ROM based on the VARSD and its directive.  The VA rates limitation of motion due to pain at the point in which the examinee can no longer continue the motion.  The Board also discussed the C&P’s recorded ROM that noted full forward flexion ROM, 6 months after separation.  Board members acknowledged the back condition appeared to have improved significantly post separation; however, at the time of separation, the CI met the 20% rating criteria.  The Board also considered code 5243 (intervertebral disc syndrome); however, this code did not support a higher rating since there was no evidence of incapacitating episodes of at least 6 weeks duration.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20%, coded 5237 for the low back pain 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 LBP condition, the Board unanimously recommends a disability rating of 20%, coded 5237 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

CONDITION	VASRD CODE	RATING	
Chronic Low Back Pain	5237	20%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140418, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

				
XXXXXXXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXXXXXXX, AR20150010586 (PD201401961)

1.  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 to modify the individual’s disability rating to 20% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						     XXXXXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA