RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02290
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040401

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Chaplain Assistant, medically separated for “chronic back pain” with a disability rating of 10%.  

CI CONTENTION:  The CI contends great toes, bilateral knees, back, and sinuses for Board consideration.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 based upon a 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:  

SERVICE PEB – 20040107	VARD - 20040623   	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5237	10%	Thoracolumbar Spondylosis and Levoscoliosis…….	5099-5003	10%	20040123	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Back Pain Condition.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic back pain condition began in February 2002 while participating in a unit run.  Radiographic (X-ray) studies of the lumbosacral spine on 4 March 2003 and 5 December 2003 were normal without evidence of intervertebral disc herniation or impingement of nerve structures.  An MRI study on 8 December 2003 was interpreted by the radiologist as unremarkable.  There was no evidence of a herniated disc or any significant disc height loss.  There was no narrowing of the neuroforamina (space through which the spinal nerve root passes).  An MRI on 29 January 2004 of the lumbar spine was normal.  Despite treatment, the CI’s back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and was referred for MEB.  The MEB NARSUM examination on 15 December 2003 (4 months prior to separation) noted low back pain radiating to neck and legs. The CI reported right greater than left numbness and tingling.  The pain and leg numbness were aggravated by prolonged standing, rucking, lifting, sweeping greater than 15 minutes.  The CI was not able to do sit-ups, push-ups, marching, jumping, airborne operations, or repetitive lifting.  Physical examination demonstrated positive radicular testing and pain with side to side motion and the initiation of extension.  There was decreased extension, right and left lateral flexion and left rotation to 20 degrees (normal 30).  At the VA Compensation and Pension (C&P) examination on 23 January 2003, performed 2 months before separation, the CI reported her whole back hurt and burned every day and her lower back sometimes locks up.  She denied any specific injury or trauma and her back condition did not affect her ordinary lifting or carrying, posture, or gait.  Physical examination showed a normal gait without muscle spasm, guarding or abnormal spinal contour.  She had normal reflexes.  Radicular tests were negative.  Thoracolumbar range of motion (ROM) after repetition was normal.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic back pain condition 10% coded 5237 (lumbosacral strain), citing tenderness to palpation.  The VA also rated the chronic back pain condition 10% coded 5099-5003 (arthritis, degenerative), based on the VA C&P examination 2 months before separation, citing  radiographic evidence of mild diffuse thoracolumbar spondylosis and levoscoliosis.  The Board agreed that a 10% rating, but no higher, was justified for combined ROM (greater than 120 degrees but not greater than 235 degrees) reported on the MEB NARSUM examination.  There was no muscle spasm or guarding severe enough to result in abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  While the CI may have experienced radiating pain from the back condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  There was no objective evidence of a radiculopathy with functional impairments such as weakness with a direct impact on fitness that were separately functionally impairing for duty.  The Board therefore concluded that additional disability rating was not justified on this basis.  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 back pain condition.  

BOARD FINDINGS:  In the matter of the chronic back pain 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.  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 20140519, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXXXXX AR20160010925 (PD201402290)

I have reviewed the enclosed Department of Defense Physical Disability Board of
Review (000 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