RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-02064
BRANCH OF SERVICE:  Army	BOARD DATE:  20150114
SEPARATION DATE:  20051129

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Armor Crewman) medically separated for chronic radiating 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 lower back pain with left sacroiliac dysfunction and disc protrusion at L5-S1” 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 radiating low back pain” as unfitting, rated 10% with likely application of Department of Defense Instruction (DoDI) 1332.39/VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please review all 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 20051013	VA* -  based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Radiating Low Back Pain	5243	10%	Chronic Low Back Pain w/Left Sacroiliac Dysfunction and Disc Protrusion at L5-S1	5238	10%	NO SHOW/STR	
Other x 0 (Not In Scope)	Other x 12	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20060328 (most proximate to date of separation (DOS)).

ANALYSIS SUMMARY:

Chronic Radiating Low Back Pain Condition.  The CI presented to the acute care clinic after returning from Iraq with a 3-year history of progressive LBP.  He reported a burning sensation with numbness in the left leg.  He was referred to physical therapy and prescribed muscle relaxant and pain medication.  Radiographic evaluation of the lumbar spine dated 9 June 2004 was normal.  A physical therapy note dated 9 June 2004 noted a diagnosis of left sacroiliac (the joint connecting the hip and the back) dysfunction.  A primary care note dated 23 March 2005 documented that the CI underwent chiropractic care for his chronic LBP.  A magnetic resonance imaging study dated 26 May 2005 revealed a small left disc protrusion at the lumbosacral level (L5-S1) with mild left lateral recess stenosis.  At an orthopedic evaluation dated 23 June 2005 the CI reported stabbing and aching left LBP; radiation to the left gluteal region; and burning, pins and needles in his left anterior thigh.  He reported daily pain, generalized weakness, and occasional giving out of the left leg.  The physical examination demonstrated a normal gait, point tenderness at the left iliac spine, and pain with motion in all planes (flexion 60 degrees, extension 15 degrees).  Maneuvers for sacroiliac pain were “extremely positive” on the left.  The examiner noted that the CI had “classic SI joint dysfunction” and did not have obvious radicular (nerve root compression) symptoms.  The examiner recommended physical therapy for the lumbar spine degenerative disc disease and left sacroiliac (SI) joint dysfunction.  The CI continued to report low back and left leg pain and was referred to the MEB.  At the narrative summary (NARSUM) examination dated 26 September 2005, the CI reported that he had undergone a second course physical therapy without pain relief.  He reported that he declined steroid injections and surgery.  He described the LBP as dull, aching, and rated six on a scale of one to ten.  He reported intermittent pain radiation down the left thigh with numbness and tingling.  The physical examination was significant for a normal gait, non-tender lumbar spine and musculature, left SI joint pain (Gaenslen), and pain with motion in all planes except left lateral flexion.  The VA rated the low back condition based on the NARSUM examination and treatment records.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB adjudicated the chronic radiating LBP as unfitting.  The PEB and VA rated the back pain condition at 10%; coded 5243 (intervertebral disc disease) and 5238 (spinal stenosis) respectively.  The Board considered whether there was evidence for a higher than 10% rating for the LBP condition.  Although left buttock and thigh neurologic symptoms (numbness and tingling) were reported, neurologic examinations were normal.  There was no evidence of muscle spasms, abnormal spinal contour, or abnormal gait.  The physical examination most proximate to separation did not evidence limitation of forward flexion between 60-85 degrees for a 20% disability rating.  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 10% for the chronic LBP condition was appropriately recommended in this case.

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 20140508, 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, AR20150010588 (PD201402064)

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