RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03448
BRANCH OF SERVICE:  Army	BOARD DATE:  20150629
SEPARATION DATE:  20070518

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Motor Transport Operator) 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.  The CI’s profile allowed for an alternate aerobic event to satisfy physical fitness standards.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “low back pain” was forwarded to the Physical Evaluation Board (PEB) as medically unacceptable IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic low back pain” 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 20070417	VA* - (~4 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Lower Back Muscle Strain	5237	10%	20070927	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 3 	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20071009 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Chronic Low Back Pain.  Service treatment record documented the report of non-traumatic LBP that begun in April 2006 while deployed to Iraq.  The CI noted that her back pain began one day after lifting heavy objects. The narrative summary (NARSUM) dated 9 March 2007 noted her back pain persisted since April 2006, accompanied by pain that radiated down her right leg.  Her condition had limited her activities and she had been on profile since then (November 2006-temporary, February 2007-permanent).  On 16 November 2006 X-rays and magnetic resonance imaging demonstrated minimal osteoarthritic changes at L5-S1 and no other pathology.  The CI participated in physical therapy and took anti-inflammatory medications without significant improvement in her condition. She did not experience any incapacitating episodes.  Having failed conservative treatment she was referred to the MEB.  At the MEB/NARSUM examination, approximately 2 months prior to separation, the CI reported persistent back pain with radiation down the right leg.  Factors that precipitated or provided pain relief were not recorded.  The MEB physical exam noted muscle spasm on the right side (“little bit), no evidence of neurological deficits, negative tests for neuropathy, and heel toe walk without difficulty.  Range-of-motion (ROM) documented forward flexion to “about 60 degrees” (90) without pain, and extension to 10 degrees (30) with pain at L5-S1.  ROM conducted for the MEB on 4 April 2007 documented forward flexion and extension on three trials, averaged 67 and 30 respectively.  At the VA Compensation and Pension dated 27 September 2007, approximately 4 months after separation, the CI reported her primary symptom was stiffness especially when sitting or standing in one position for prolonged period of time.  She reported numbness in the right leg, but no pain, and noted that her condition affected her ability to walk at times but had not caused any incapacitation.  She was 23 weeks pregnant at the time of the evaluation.  The CI also noted that her back condition had not affected her occupation or activities of daily living.  She had daily flare-ups that lasted for about 2 hours, and used no assistive device for ambulation.  Physical exam noted tenderness in the paraspinal muscles in the lower back area, and no evidence of fatigue, incoordination, or neuromuscular deficits.  Gait was normal.  Flexion of thoracolumbar spine was recorded at 90 degrees (normal), extension was 20 (0-30).

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the condition 10% for pain coded 5237 (lumbosacral strain).  The VA rated 10% code 5237 for reduced ROM and pain.  A higher rating of 20%, requiring spasms producing abnormal gait, or abnormal curvature of the spine; or forward flexion not greater than 60 degrees, was not supported by the available evidence.  The Board noted the ROM for MEB documented average forward flexion of 67 degrees and average extension of 30 degrees.  There was no evidence of incapacitating episodes for a higher rating under 5243.  There is no VASRD pathway to a rating higher than the minimal compensable rating.  In addition, there was no evidence of ratable peripheral nerve impairment in this case, since no motor weakness was present and sensory symptoms had no functional implication.  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 back pain condition.

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 LBP 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 20140628, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB	0 6 Jul 2016

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, AR20160003055  (PD201403448}

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 ( ) OVA