RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02330
BRANCH OF SERVICE:  Army	BOARD DATE: 20150630
SEPARATION DATE:  20040818

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Human Resource Specialist) medically separated for chronic low back pain (LBP).  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty (MOS).  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The back pain condition, characterized as “chronic LBP,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “chronic LBP without neurologic abnormality,” as unfitting, rated 10%.  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 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 20040603	VA* - (~2 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP	5299-5237	10%	Intervertebral Disc Syndrome	5243	10%	20041007	
Other x 0 (Not In Scope)	Other x 7	
RATING:  10%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20041130(most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Chronic LBP Pain Condition.  The service treatment record revealed that the CI was “kicked in the back” in April 2001.  She denied any radicular component to her painful back symptoms.  Initial X-rays of the thoracic and lumbar spine were normal.  Despite physical therapy and manipulation treatment, her low back symptoms continued.  The record also indicated that the CI was involved in a motor vehicle accident in June 2003 and again complained of LBP.  Repeat lumbar X-rays were normal.  A magnetic resonance image conducted on 6 January 2004 (7 months prior to separation) revealed a single-level lumbosacral disc extrusion.  Secondary to continued LBP without radicular symptoms, she was permanently profiled on 20 April and sent for a MEB.  The MEB narrative summary (NARSUM) examination on 20 April 2004 provided a historical perspective of the CI’s past treatments noting the inability to lift her 28 pound child due to her painful condition.  The physical examination (PE) revealed lumbosacral tenderness and limited thoracolumbar range-of-motion (ROM).  Her gait was normal.  Bilateral straight leg raises were normal and there was no comment in regards to spinal painful motion or peripheral weakness.  Her diagnosis was chronic LBP; L5-S1 disc extrusion.  Her permanent profile listed the same condition as the sole diagnosis.  The commander’s statement clearly denoted the CI’s inability to perform in her MOS.  At the VA Compensation and Pension examination on 7 October 2004, the CI reported a constant and localized 8/10 LBP described as aching and sharp in nature; aggravated by physical activity/stress and relieved with medication.  She denied periods of incapacitation and her functional impairment listed the inability to do physical activities when in pain.  The PE revealed decreased and painful motion of the thoracolumbar spine.  Bilateral straight leg raises were ‘positive’ without noting a measured degree resulting in symptoms.  Any forms of radicular pain, tenderness, or spasms were not present.  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 ~4 Mo. Pre-Sep
(20040420) 	VA C&P~2 Mo. Post-Sep
(20041007) 	
Flexion (90 Normal)	60 (cusp)	85 (cusp)	
Extension (30)	15	20	
R Lat Flexion (30)	20	25	
L Lat Flexion (30)	25	25	
R Rotation (30)	30	25	
L Rotation (30)	30	25	
Combined (240)	180	205	
Comment	tenderness	painful motion	
§4.71a Rating	20%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  Although the PEB and VA titled the unfitting back condition slightly differently, they both utilized similar primary codes of 5237 (lumbosacral strain) and 5243 (intervertebral disc syndrome) respectively; with the PEB not listing a substantiation and the VA citing limited ROM.  Board members first acknowledged the ROM values reported by the MEB examiner, (4 months prior to separation) were significantly worse than those reported in the 4 months after separation VA examination having differing implications regarding the Board's final rating recommendation.  The Board thus carefully deliberated its probative value (PV) assignment to these differing evaluations, and carefully reviewed the file for corroborating evidence in the 12-month period prior to separation.  Members agreed that both examinations had nearly equal PV with neither one being outside this Board’s realm of investigative timeline.  An additional note to acknowledge in this case was the surgical procedure of a bilateral breast reduction that was conducted approximately 3 weeks prior to the charted NARSUM examination.  Board members considered the close proximity of the breast surgery to the MEB examination and consensus was that the physical findings at that time were not a pure or specific identification of her low back pathology, but rather a component of increased pain in performing a maneuver (having her breasts suspend downward with low back flexion) being just 3 weeks after major surgery.  In other words due to pain in the breasts incisions, she attenuated the inciting maneuver of back flexion.  Given that thought process, the improvement 8 weeks later further indicated healing from the surgical procedure and thus less pain with subsequent improved motion.  There was no additional documentation for incapacitating episodes and or evidence of localized spasms which could have achieved a higher rating under the applicable §4.71a criteria.  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 10% for the back 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 low back condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.

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 20140513, 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 XXXXXXXXXXXXXXXXXXXX, AR20150018407 (PD201402330)

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