RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02424
BRANCH OF SERVICE:  Army	BOARD DATE:  20150519
SEPARATION DATE:  20050428

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (D3 Calvary Scout) medically separated for chronic low back pain.  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 P3U3L3 profile and referred for a Medical Evaluation Board (MEB).  The “low back pain” 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 low back pain” as unfitting, rated 20%, with likely application 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 20050214	VA* - (~4 Mos. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5237	20%	Chronic Lower Back Pain	5299-5237	20%	20050104	
Other x 0 (Not In Scope)	Other x 3	
RATING:  20%	RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20050503 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  The CI sustained a blast injury in April 2003 while deployed in Iraq, which resulted in chronic low back pain radiating to the right lower extremity.  Magnetic resonance imaging (MRI) studies performed in September and October 2003 revealed a cystic mass in the lumbar spinal canal.  A neurology note dated 4 November 2003 documented a normal electromyogram (negative for nerve root compression).  The examiner opined that there was “no clear organic etiology for the severe disabling back pain.”  The CI was not tolerant of physical therapy and was referred to pain management.  An MRI myelogram dated 03 February 2004 confirmed the post-traumatic cyst (Pseudomeningocoele).  A neurosurgical evaluation concluded that the surgical intervention was not required.  The CI continued with pain management treatments to include facet blocks, epidural injections, anti-inflammatory medications, and narcotic medications without significant or permanent relief of the low back pain.  The narrative summary (NARSUM) noted that the CI wore a form fitted body brace for support and rated that pain 4/10.  The examiner noted that the CI was on multiple narcotic and anti-inflammatory medications.  The physical examination demonstrated that the CI wore a back brace, abnormal posture angled at 40 degrees of flexion, and an antalgic gait.  There was tenderness to palpation over the lumbosacral to mid thoracic spine.  

At the VA Compensation and Pension examination performed 4 months before separation, the CI reported constant pain radiating down his right lower extremity.  The pain was described as aching and sharp.  It was rated 9/10 with difficulty standing, walking, bending, twisting, and lifting.  The physical examination demonstrated a forward flexed posture, thoracolumbar paraspinous muscle spasm, and tenderness to palpation.  The neurologic examination was normal and without evidence of radiculopathy.  The goniometric range-of-motion (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 ~5 Mo. Pre-Sep
(20041123) 	VA C&P ~4 Mo. Pre-Sep
(20050104) 	
Flexion (90 Normal)	40	70	
Extension (30)	0	20	
Comment		Muscle spasm, abnormal gait	
§4.71a Rating	20%	20%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB adjudicated the chronic low back pain as unfitting. The PEB and VA rated the condition at 20%, coded 5299-5237 (analogous to lumbosacral strain).  The Board considered whether the evidence supported a higher than 20% rating.  There was no evidence of favorable ankylosis of the entire thoracolumbar spine, or forward flexion to 30 degrees or less for a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 20% for the chronic low back pain 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 low 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.  

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 20140527, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

XXXXXXXXXXXXXXXXXXXX
President
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 XXXXXXXXXXXXXXXXXXXX, AR20150014442 (PD201402424)

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						     XXXXXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA