RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02269
BRANCH OF SERVICE:  Army	BOARD DATE:  20150225
SEPARATION DATE:  20080613

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, (Aircraft Structural Repairer) medically separated for a lumbar spine condition.  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 condition “lumbar intervertebral disk degeneration” was forwarded as the sole submission to the Physical Evaluation Board (PEB) IAW AR 40-501.  The Informal PEB adjudicated “low back pain” as unfitting, rated 10%, citing criteria of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider 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 20050829	VA* - based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5237	10%	Mechanical Low Back Pain … DDD 	5243	10%	STR + VA Treatment Records	
Other x 0 (Not In Scope)	Other x 10 	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20090213 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Lumbar Spine Condition.  The STR documents an initial onset of low back pain in 2003 during a prior enlistment (Army).  Imaging (magnetic resonance imaging) from that period demonstrated some mild degenerative disc disease (L3–L5).  The CI electively separated in 2004 and re-enlisted in November 2007 with a medical waiver for his back condition.  The earliest STR entry for the condition from the new enlistment is from early January 2008 which records a complaint of back pain and spasm without radicular complaints.  That note and another one a few days later mention gait disturbance, but subsequent entries document a normal gait with no further mention of abnormal gait.  Multiple STR entries confirm normal neurological findings and 5/5 strength, and none document significant radicular symptoms or abnormal neurological exam findings.  Various entries document grossly normal range-of-motion (ROM), although noting painful motion.  There are no STR entries documenting significant ROM limitation or periods of incapacitation.  Formal ROM measurements for the MEB were provided by physical therapy in April 2008 (2 months prior to separation), recording flexion to 65 degrees (normal 90 degrees) and combined ROM of 165 degrees (normal 240 degrees).  A normal gait and normal spinal contour were also documented.  An orthopedic narrative summary (NARSUM) was conducted on 11 March 2008 (3 months prior to separation), and documented continuing back pain precipitated by running and lifting.  Transient bilateral radicular pains (no sensory or motor complaints) were noted which resolved with rest, and it was opined that the CI was not a surgical candidate.  The NARSUM physical exam documented tenderness, without comment regarding gait or spasm; recorded normal neurological findings (5/5 strength); and noted a flexion of “approximately 70 degrees.”  There was no temporally probative VA or other after separation evidence in this case.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating was consistent with the MEB ROM evidence (corroborated by the STR) under the §4.71a spine formula.  There was no evidence of abnormal gait or contour at separation which would achieve a higher rating under those criteria.  There was no evidence of ratable peripheral nerve 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 concluded that there was insufficient cause to recommend a change in the PEB adjudication of the lumbar spine 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 lumbar spine 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 20140517, 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 XXXXXXXXXXXXXXXXXXX, AR20150018794 (PD201402269)

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