RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03133
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050630

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

CI CONTENTION:  The applicant requests all conditions be considered.  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 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:  

SERVICE PEB - 20050331	VARD - 20050805	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5237	0%	Lumbar Spine Scoliosis	5242	0%	20050511	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain Condition.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic low back pain condition began in 2003 during basic training and worsened after a ruck march in August 2003.  Diagnostic imaging in May 2004 indicated mild curvature of the thoracolumbar junction.  Evaluation by orthopedics concluded with a diagnosis of chronic low back pain with scoliosis (lateral curve of the spine-usually developmental) as a possible contributing factor.  There was no surgical indication.  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 an MEB.  

At the time of the chiropractic clinic appointment on, 4 November 2004, the CI reported 6/10 intermittent low back pain with radiation into the bilateral lower extremities.  On examination straight leg raise testing for radiculopathy was negative bilaterally.  The range of motion (ROM) appeared to be limited in some planes.  

During the orthopedic clinic consult for the MEB, on 6 December 2004, the CI reported occasional numbness which went down from the top of her thighs to her feet and that she could barely lift 30 pounds.  The examiner noted that the CI had been seen over 20 to 25 times for her back and that the CI indicated that chiropractic made the back condition worse.  On examination, the back was tender to palpation.  Reflexes and sensation were normal and provocative testing for radicular symptoms was negative.  

The MEB NARSUM examination on 27 January 2005, performed 5 months prior to separation, noted complaints of chronic back pain.  There was tenderness to palpitation from the mid thoracic to the upper lumbar area and over the sacroiliac joint.  Provocative testing for radiculopathy was negative.  She was able to heel, toe, and duck walk; but had back pain on arising from the squatting position.  “The remainder of the exam was normal.”  At the time of the physical therapy clinic appointment on, 3 February 2005 (4 months before separation), the examiner recorded the ROM as forward flexion of 85 degrees (90 normal) with a combined ROM of 200 degrees (240 normal).  

At the VA Compensation and Pension (C&P) examination on 11 May 2005, performed 1 month before separation, the CI reported her back condition did not interfere with ordinary carrying or lifting.  The physical examination showed a normal gait, and maintained curvature of the lumbosacral spine.  The sensory perception and reflexes were normal.  Provocative testing for radiculopathy was negative.  The ROM was forward flexion of 90 degrees (90 normal) with a combined rom of 240 degrees (240 normal) without restriction of pain.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic low back pain condition 0% coded 5299-5237 (lumbosacral strain), citing normal ROM not limited by pain with her pre-existing scoliosis contributing to her back pain.  The VA rated the lumbar spine scoliosis condition 0% coded 5242 (degenerative arthritis of the spine), based on the VA C&P examination a month before separation, citing a full ROM with X-ray evidence of mild levoscoliosis.  

The Board agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) reported on the physical therapy examination (or tenderness documented on multiple other record entries).  There was no associated radiculopathy for separate peripheral nerve rating.  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 recommends a disability rating of 10% for the chronic low back pain condition, coded 5237.  

BOARD FINDINGS:  In the matter of the chronic low back condition, the Board unanimously recommends a disability rating of 10%, coded 5237 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 to medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Low Back Pain	5237	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140602, 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 XXX, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXXX AR20160008656 (PD201403133)

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