RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02885
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20020618

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Carpentry and Masonry Specialist, medically separated for “low back pain,” with a disability rating of 10%.

CI CONTENTION:  The applicant requests consideration of all conditions.  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 - 20020422	VARD - 20040121	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5295	10%	Low Back Pain	5242	10%	20030902	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Low Back Pain.  The 2002 VASRD coding and rating standards for the spine, which were in effect at the time of permanent separation, were changed to the current §4.71a rating standards on 26 September 2003, following the CI’s date of separation.  Although the VA in this case rated the condition according to the current standards, IAW DoDI 6040.44 this Board must consider the appropriate rating for the CI’s back condition at separation based on the VASRD standards in effect at the time of separation.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in January 2001 but worsened after a motor vehicle accident in March 2001.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  Imaging studies showed small central disc protrusions at L4-5 and L5-S1 without neuroforaminal stenosis.  The MEB forwarded “lower back pain” for PEB adjudication.

At a physical medicine evaluation on 25 September 2001 (9 months prior to separation) the CI reported low back pain that radiated to both hips.  Examination showed trunk flexion of 90 degrees (normal 90 degrees by current standards) and extension of 30 degrees (normal 30 degrees by current standards).  Lower extremity muscle strength, sensation and reflexes were normal.  Diffuse lower lumbar and upper sacral tenderness was present.  The MEB NARSUM examination on 22 march 2002 (3 months prior to separation) noted a complaint of daily lower back pain that was relieved only with medication or lying flat.  Pain was characterized as 10/10 in severity and occurred after walking, standing and bending.  She could not march, run, wear military gear, perform sit-ups or push-ups, or lift more than 20 pounds.  Physical examination showed lower lumbar tenderness, forward flexion of 90 degrees and “full range of motion” in extension and rotation.  The left sacroiliac joint displayed tenderness and spasm.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back pain condition 10%, coded 5295 (lumbosacral strain), citing “pain on motion” as the rationale.  The VA rated the lumbar spine condition 10% under a newer spine code (5242, degenerative arthritis of the spine), but as previously elaborated the Board must use older codes in effect at the time of separation.  Board members agreed that evidence of muscle spasm and loss of lateral spine motion was lacking, and therefore the next higher 20% rating was not justified under the 5295 code.  There was no evidence of recurring attacks consistent with intervertebral disc syndrome that would justify a rating via the 5293 code (intervertebral disc syndrome).  Under the 5292 code (spine, limitation of motion of, lumbar) a 20% rating is supported for “moderate” limitation of motion.  However, the available evidence did not depict this degree of limitation.  The Board concluded therefore that a rating higher than the PEB’s 10% was not supported.  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 low back pain condition.  

BOARD FINDINGS:  In the matter of the 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.  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 20140515, 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

17 NOV 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160017020 (PD201402885)

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