RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03537
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030715

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Petroleum Supply Specialist, medically separated for “chronic low back pain,” with a disability rating of 10%.

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 - 20030514	VARD - 20031125	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5295	10%	Degenerative Joint Disease and Degenerative Disc Disease of the Lumbar Spine	5293-5292	20%	20030711	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was first seen for low back pain (LBP) on 21 November 1997 when he reported a 2-month history of pain since he had fallen onto a floor while buffing.  He was treated with medications and duty restrictions and seen several more times over the next 8 months.  The record then falls silent until he was seen in the emergency room on 14 October 2001 after he was involved in a roll-over accident with a forklift.  The examination and radiographic (X-ray) studies were unremarkable and he was returned to duty the next day.  His pain persisted and repeat X-rays on 27 March 2002 were also normal.  
At the time of the orthopedics on 1 April 2002, his back was tender and spasm was present.  The range of motion (ROM) was restricted to his knees in flexion.  A magnetic resonance imaging (MRI) on 29 April 2002 showed degenerative disc disease (DDD) at L5-S1, but nerve root impingement was not present.  He continued treatment with duty restrictions, medications, and physical therapy (PT).  

An orthopedic re-evaluation on 17 October 2002 showed muscle tenderness and reduced and painful ROM.  On flexion, he could bring his fingertips to the floor (normal); extension and side bends were reduced by 50%.  He was then treated with epidural steroid injections (ESIs) with an 80% reduction in his pain; however, he was still unable to meet full duty requirements.  He also reported numbness and tingling in his left foot.  

Despite treatment, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “chronic low back secondary to degenerative disk disease at the L5-S1 without evidence of herniation” for PEB adjudication.

The MEB NARSUM examination on 25 April 2003 (3 months prior to separation) physical examination showed normal strength and a normal gait.  On flexion, he could bring his fingertips to his knees and had 50% reduced extension and side bending.  Sensation was reduced on both the inside and outside (medial and lateral) aspects of his left foot.  Diffuse tenderness of the back was present and no spasm was recorded.  

The MEB examination (recorded on DD Forms 2807 and 208) was performed in conjunction with the VA Compensation and Pension (C&P) examination on 11 July 2003, 4 days before separation, the CI reported severe pain, but was able to walk, bend, stoop, squat and rapidly change position without guarding or evidence of pain.  The demonstrated flexion was 70 degrees, but the CI demonstrated full ROM when donning and doffing his clothes.  The examiner noted “physical behavior did not appear consistent with demonstrated physical activity versus voiced limitation.”  The VA neurology C&P was accomplished 20 April 2004, 9 months after separation, the CI was noted to have normal strength and a normal gait.  The ROM was full and did not decrease with repetition.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the chronic back condition 10%, coded 5299-5295 (analogous to lumbosacral strain), with probable use of the interim spine rules.  The VA also rated the CI under the interim spine rules, but rated it at 20%, coded 5293-5292 (analogous to intervertebral disc syndrome and limitation of the lumbar spine).  The CI’s voiced limitations were not consistent with his observed function and the unobserved ROM was normal.  Although there was insufficient limitation of motion to support a minimum rating, the Board agreed a 10% rating was justified for the presence of painful motion.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  
The Board considered if a separately unfitting radiculopathy was present at separation, but the motor function and gait were both normal on multiple examinations.  The Board concluded therefore that this condition could not be recommended for additional disability rating.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the back pain condition.  

BOARD FINDINGS:  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.  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 20140710, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

27 JUL 2016

MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-00), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXX, AR20160011483 (PD201403537)

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.

Enclosure

CF:
( ) DoD PDBR
( ) DVA