RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02911
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20020825

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Cryptologic Linguist, medically separated for “low back pain” with a disability rating of 0%.  

CI CONTENTION:  “Please consider 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 - 20020529	VARD - 20021007	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain after Blunt Trauma	5299-5295	0%	Status Post Blunt Trauma, Low and Mid Back	5292	10%	20020801	
			Lipoma, Lumbar Area	7899-7804	10%	20020801	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Low Back Pain after Blunt Trauma Condition.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back pain began after blunt trauma in April 2001 when he was hit in the back by a large antenna that fell off a moving vehicle.  He also reported pain radiating to his upper buttocks and occasionally to his right thigh when walking.  X-ray studies 2 May 2001 showed no intervertebral disc herniation or impingement of nerve structures.  There was a very minute degree of scoliosis (curvature of the spine).  The CI underwent physical therapy for 14 months and was evaluated by orthopedics in October 2001 for a gait analysis which noted what appeared to be function leg length deformity (left shorter than the right) with a left hip drop and a left shoulder drop.  The CI was given a Spenco insole for his left shoe to correct the leg length issue.  The CI stated at the time that he felt more balanced wearing the insole.  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 forwarded “Lower back pain, due to blunt contusion, no evidence of spinal, disc or neurologic injury.” for PEB adjudication.  

At the MEB examination (recorded on DD Forms 2807 and 2808) dated February 2002, 6 months prior to separation, the CI reported low back pain with inability to march, ruck, or sit for prolonged periods.  Physical examination showed limited flexion and extension of the spine.  

At the NARSUM examination dated 12 April 2002, 5 months prior to separation, the CI reported constant lower back pain that varies from mild to severe, depending on the position and activity level.  The pain was worsened by lifting, exercise, bending over, prolonged standing, running, marching, and climbing.  He denied radiation of the pain distally.  Physical examination showed no abnormal curve, deformity, swelling, ecchymosis (discoloration under the skin caused by bruising), erythema (reddening of the skin from injury), or other evidence of injury.  Strength, reflexes and sensation were normal.  The examiner was silent regarding gait and back range of motion (ROM).  At a subsequent physical therapy examination 9 May 2002 the CI reported burning pain with prolonged walking, sitting, or repeated bending.  Physical examination noted normal trunk ROM, “good (not normal) strength” of trunk musculature, and normal gait.  

At the VA Compensation and Pension (C&P) examination on 1 August 2002, performed 24 days before separation, the CI reported chronic low back and mid back pain.  Physical examination showed lumbar ROM of “flexion is 0 to 70 degrees and right and left lateral flexion is normal at 0 to 25 degrees.  The anterior flexion showed it to be normal.  It is usually 0 to 90 degrees.  Hyperextension 0 to 10 degrees, which is normal.”  There was some tenderness on a large lipoma (benign tumor) over the paralumbar area on the right.  Straight leg raise (for radicular symptoms) was negative.  The examiner was silent regarding gait, spasms and spinal contour.  

The Board directed attention to its rating recommendation based on the above evidence.  In accordance with DoDI 6040.44, the Board is required to recommend a rating IAW the VASRD in effect at the time of separation.  The Board noted that the 2002 Veteran Administration Schedule for Rating Disabilities (VASRD) standards for the spine, which were in effect at the time of separation.  The criteria for 5293 (intervertebral disc syndrome) was changed in September 2002 (prior to the VARD), and then changed to the current §4.71a rating standards in September 2003.  The Board must correlate the above clinical data with the 2002 rating schedule; applicable diagnostic codes include: 5292 (limitation of lumbar spine motion); 5293 (intervertebral disc syndrome); and 5295 (lumbosacral strain).  

The PEB rated the low back pain after blunt trauma condition 0% coded 5299-5295 (lumbosacral strain), citing injury after blunt force trauma with normal bone scan, no focal neurological deficit and an unremarkable examination.  The VA rated the low back pain after blunt trauma condition 10% coded 5292 (limitation of motion of lumbar spine), based on the VA C&P examination 24 days before separation, citing slight limitation of forward flexion.  The VA also rated the lumbar area lipoma condition 10% coded 7899-7804 (scars, superficial, tender and painful on objective demonstration) citing tenderness.  

The Board deliberated on the interpretation and probative value of the examinations in evidence and the totality of the record.  The source MEB NARSUM examination conducted 5 months prior to separation, did not conduct ROM measurements, and followed the MEB examination documenting limited flexion and extension.  The VA examination was closer to and prior to separation, provided more comprehensive ROM testing, aligned with the remainder of the record, and was therefore adjudged to have the highest probative value for rating at separation.  

The Board agreed that a 10% rating, but no higher, was justified for slight limitation of flexion reported on the VA examination.  There was insufficient evidence of moderate intervertebral disc syndrome for any higher rating under code 5293.  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.  The lumbar area tender lipoma (one or two scars that are unstable or painful, 10%) reported on the VA examination was not identified at the MEB NARSUM examination, conducted 5 months prior to separation, and there was no indication the condition affected the CI’s ability to wear military equipment or perform his military functions.  

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the low back pain after blunt trauma condition, coded 5292.  

BOARD FINDINGS:  In the matter of the low back pain after blunt trauma condition, the Board unanimously recommends a disability rating of 10%, coded 5292 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Low Back Pain after Blunt Trauma	5292	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140606, 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 XXXXXXXXXXXXXXXXXXXXX, AR20160017022 (PD201402911)

1.  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, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA