RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03555
BRANCH OF SERVICE:  Army	BOARD DATE:  20150624
SEPARATION DATE:  20030822

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a traditional drilling Reserve E-2 (did not complete IET) medically separated for low back pain (LBP).  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty which is why one was not awarded.  The profile allowed for an alternate aerobic event to satisfy physical fitness standards.  He was issued a permanent L3E3 profile and referred for a Medical Evaluation Board (MEB).  The “low back pain” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated the LBP condition as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  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 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 20060914	VA* - (~10 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain, without Neurologic Abnormality…	5299-5237	10%	Lumbosacral Strain	5242	20%	20070914	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 0 (equals SC, NSC & deferred)	
RATING:  10%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20070925 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Low Back Pain Condition.  The record shows that the CI was apparently injured in a motor vehicle accident in late 2002 while in basic training.  While in the back of a truck, he fell and then other soldiers fell onto him.  He was able to complete basic training, but had recurrent problems in advanced infantry training.  On 17 March 2003, X-rays of the lumbar spine showed degenerative changes suggestive of pre-existing disease.  A magnetic resonance imaging (MRI) performed on 18 April 2003 showed degenerative changes and “apparent compression of the exiting L5 nerve root.”  A neurosurgery note dated 21 May 2003 documented a normal heel and toe walk, “ROM (range-of-motion) o.k.,” and a normal neurological examination.  He was placed in medical holdover status and treated with physical therapy (PT).  A PT note dated 5 June 2003 documented a normal ROM and a normal neurological examination.  In orthopedics on 23 June 2003, he was noted to have a normal gait and neurological examination.  His training was finished other than the requirement to pass another physical fitness test.  A repeat X-ray was consistent with spasm.  A PT evaluation on 9 July 2003 documented a normal gait and ROM.  A follow-up on 22 July 2003 documented a normal gait, but painful motion (greatest in extension).  He was again seen in PT on 12 August 2003 and noted to have a normal gait and ROM.  The CI was cleared to return to duty and allowed an alternate physical fitness test.  The record then falls silent until 19 January 2004 when the CI was seen by a civilian physical medicine specialist back at his home.  The CI reported persistent and constant pain, but was able to run and perform daily sit-ups and push-ups.  Extension was full, but flexion, lateral bending, and rotation were all reduced to 75% of normal.  Neither tenderness nor spasm was present.  The neurological examination was normal.  An injection of a steroid and anesthetic was accomplished and medications were prescribed.  Minimal benefit was received from this treatment.  A repeat MRI on 26 February 2004 showed multi-level degenerative disc disease and degenerative joint disease.  At a follow up physical medicine appointment on 5 March 2004, his condition was stable and he reported that he had been accepted by a unit in Virginia and was moving there.  He was then seen in PT on 27 April 2004 at the next duty location, in Virginia, and noted to be in an MEB.  It is not clear why the MEB was stopped, but the MEB examiner noted that the CI was still attached to the unit in Texas.  The ROM was essentially normal other than flexion reduced by 10 degrees.  The gait was normal.  The record then again falls silent until 11 May 2006 when he again has ROM measurements in PT (below) for an MEB.

At the MEB examination on 18 May 2006, 6 months prior to separation, the examiner recorded that flexion and extension were limited and that the ROM was painful.  Tenderness was present.  The neurological examination was normal.  The narrative summary was dated 21 July 2006, 4 months prior to separation from the Reserves.  The examiner documented that the CI had followed a home exercise program over the 2 years since his evaluation in 2004 for an MEB.  He had not been treated otherwise.  The gait and neurological examination were normal.  The ROM was reduced for flexion and limited by pain.  It appears that these values are those obtained by the PT examiner two months earlier, but this is not specified in the narrative.  No radiculopathy was present.  At the VA Compensation and Pension exam performed 10 months after separation from the reserves, the CI reported that he worked in contracting at Pepsico.  Incapacitation was denied.  He was able to walk 1/4 mile or for 30 minutes.  No assistive device was used.  On examination, there was no abnormal curvature, spasm, or guarding; tenderness was present.  The neurological examination was normal as was the gait.  The ROM was reduced as charted below.  Repetition did not result in further limitation in motion.  The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.  

Thoracolumbar ROM
(Degrees)	PT ~6 Mo. Pre-Sep	NARSUM ~4 Mo. Pre-Sep	VA C&P ~10 Mo. Post-Sep	
Flexion (90 Normal)	65 (60,65,65)	65 (63)	60	
Combined (240)	215	215	190	
Comment	Painful motion	Limited by pain	DeLuca negative	
§4.71a Rating	10%	10%	20%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition at 10%, coded 5299-5237 (analogous to lumbosacral strain).  The VA rated the back at 20%, coded 5242 (degenerative arthritis of the spine).  The Board considered the evidence.  Flexion was typically measured greater than 60 degrees in the majority of clinical visits leading up to separation from the reserves.  Many of these were, however, over 2 years prior to separation.  The evaluation is hampered by the lack of clinical visits the last 2 years leading up to separation as the CI pursued a home exercise program.  However, the fact that he did not require treatment suggests a limited impairment from the back during this period of time.  There are two examinations (vice one) and both are closer to separation than the VA examination.  In addition, they are more consistent with the majority of values in evidence.  The MEB values (done by PT) are therefore assigned a higher probative value for rating purposes.  These support a 10% rating.  The Board found no route to a higher rating.  The Board also determined that an unfitting radiculopathy was not present at separation.  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 chronic 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 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 20140728, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB
 
DEPARTMENT OF THE ARMY
ARMY REVIEW BOARDS AGENCY 251 1BTH STREET SOUTH, SUITE 385
ARLINGTON, VA  22202-3531

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  XXXXXXXXXX, AR20160003326  (PD201403555)

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 i554a, 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: