RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX		CASE:  PD-2014-02146
BRANCH OF SERVICE:  Army		SEPARATION DATE:  20061014

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Bradley Fighting Vehicle System Maintainer) medically separated for “chronic low back pain (LBP) with mild herniated disc,” rated at 10%.  

CI CONTENTION:  The CI requested that the Board review all of his contentions.  The 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 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: 

IPEB - Dated 20060811	VA* - (~6 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5299-5237	10%	Lumbar Strain	5237	20%	20070426	
Other MEB/PEB Conditions x 0 (Not in Scope)	Other x 2 	
RATING:  10%	RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20070622 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Chronic Back Pain Condition.  The service treatment record (STR) indicated that the CI developed LBP shortly after participating in combative training as part of pre-deployment training in August 2005.  Initial radiographs revealed minimal disc disease of the lumbosacral spine.  Despite physical therapy (PT) and medication, his LBP continued throughout his deployment and beyond.  Repeat radiographs performed in March 2006 revealed a progression of his lumbosacral disc disease to include a herniation of L5-S1 without adjacent nerve compression.  Electro-diagnostic testing was performed in April 2006 due to subjective complaints of radicular pain extending into both legs; results were normal.  Specialty consultation did not recommend surgical intervention, but rather pain management.  He was permanently profiled in April 2006 and referred to an MEB.  The commander’s statement validated the CI’s inability to adequately perform his MOS required duties due to his physical condition.  At the MEB orthopedic narrative summary (NARSUM) examination (17 July 2006; 3 months pre-separation), the CI endorsed LBP made worse with sitting or standing greater than 10 minutes or walking 1/2-mile.  He additionally endorse the inability to perform his soldiering activities which include running, jumping, sit-ups, push-ups, 3-5 second rushes, digging a fighting position, running with a fighting load of 48 pounds, use of the flack vest, Kevlar, and ruck sack.  His physical examination (PE) revealed thoracolumbar ROM as guarded, decreased and painful.  Lumbar spasms were present.  His gait, heel/toe stance was normal.  Neuro sensory and motor parameters were normal.  His pain level was assessed as ‘slight’ and ‘constant’.  His diagnosis remained as chronic LBP with mild herniated disc at L5/S1.  At the VA Compensation and Pension (C&P) examination (26 April 2007; 6 months post-Service separation), the CI reported low back discomfort averaged at 7/10 pain scale.  His focused lumbar spine PE revealed decreased and painful motion.  Spasms were identified in the lower lumbar spine.  Gait and heel/toe walk was normal.  Neuro sensory and motor was intact.  His diagnosis remained chronic lumbar strain.  The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Thoracolumbar ROM
(Degrees)	MEB ~3 Mo. Pre-Sep
(20060717) 	VA C&P ~6 Mo. Post-Sep
(20070426) 	
Flexion (90 Normal)	50	50	
Extension (30)	10	10	
R Lat Flexion (30)	30	20	
L Lat Flexion (30)	30	15	
R Rotation (30)	20	25	
L Rotation (30)	20	25	
Combined (240)	160	145	
Comment	painful motion; guarding; (+) spasm	painful motion;
 (+) spasm	
§4.71a Rating	20%	20%	

The Board directed attention to its rating recommendation based on the above evidence.  Although the Service and VA titled the unfitting back condition differently, they both utilized (in various combinations) the same 5237 code (lumbosacral strain) and rated at 10%.  Board members deliberated and agreed that sufficient evidence of limitation of motion was present in both pre and post-Service separation examinations to support a 20% impairment rating IAW VASRD §4.71a.  Additionally, members concluded that there was no evidence of a ratable neurologic impairment or documentation of incapacitating episodes in this case which would provide for additional or higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the chronic 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 low back 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 Back Pain	5237	20%	
RATING	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140512 w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander, US Army Physical Disability Agency (AHRC-00), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXX, AR20160004374 (PD201402146)

i. 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, accept the Board's recommendation to modify the individual's disability rating to 20% without re-characterization 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:

CF:
( ) DoD PDBR
 ( ) OVA