RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE:  PD-2014-03761
BRANCH OF SERVICE:  Army		SEPARATION DATE:  20030429

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Aircraft Armament, Avionics, Electrical Repairer, 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 - 20030109	VARD - 20030327	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP	5299-5295	10%	Mechanical LBP with Bilateral LS Spondylolysis	5295	10%	20030228	
Stage 2B Nodular Hodgkin Lymphoma	Not Unfitting	Stage 2B Nodular Hodgkin Lymphoma	7715	0%	20030228	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY: 

Low Back Pain (LBP).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the low back pain condition began approximately 3 years prior to referral for MEB.  Lumbar spine diagnostic imaging (X-ray) showed mild anterior-inferior vertebral spurring.  Lumbar spine diagnostic imaging (CT) showed bilateral spondylolysis (deficient development or degeneration of a vertebral component [pars interarticularis]) at L5.  Lumbar spine diagnostic imaging (MRI) showed bilateral L5 spondylolysis without evidence of spondylolisthesis (forward displacement of vertebra after a fracture [pars interarticularis]) and no evidence of disc disease.
In the 6 May 2002 musculoskeletal MEB NARSUM consultation by physical medicine and rehabilitation, 12 months before separation, the CI reported that LBP started after three consecutive bad parachute landing falls in 1999.  The CI complained of increasing LBP in spite of conservative therapy (activity modification, profiles, convalescent leave, and physical therapy).  Pain was exacerbated by prolonged standing, prolonged walking, sit-ups, flutter kicks, repetitive bending, lifting, and loadbearing (rucksack, flack vest, LBE, or helmet) and relieved by moist heat, massage, stretching, and medications.  The focused musculoskeletal examination revealed a symmetrical and straight spine (T1 to S1) without gross muscle atrophy.  There was tenderness on the right gluteal muscles with pressure on the sciatic notch and on the muscles themselves.  Strength, sensation, and deep tendon reflexes were normal.  The examiner recounted the findings of the X-ray, CT, and MRI.  The diagnosis listed mechanical LBP with superimposed bilateral spondylolysis.  Active range of motion (ROM), measured by physical therapy, 10 months before separation, with an inclinometer, was lumbosacral flexion of 55 degrees, lumbosacral extension of 5, lumbar flexion of 40 (with pain), lumbar extension of 0 (with pain), and bilateral lumbar side bending of 15 degrees (with pain).  In the 6 November 2002 MEB NARSUM, 6 months before separation, the CI complained of chronic LBP since 1999 with no evidence of an obvious trauma.  Pain was exacerbated by prolonged standing, walking, running, bending, and lifting and relieved by medications.  The back examination revealed bilateral paraspinal muscle spasms and tenderness in the lumbar spine region.  Lumbar ROM was flexion of 55 degrees, extension of 5, and bilateral side bending of 15 degrees with pain at extreme ranges of motion.  The supine and seated straight leg raise tests (assess for herniated disc causing sciatic nerve root [L5-S1] radiculopathy) were negative.  The bilateral lower extremities were grossly neurovascularly intact.  The examiner recounted the findings of the X-ray and MRI.  The diagnosis listed bilateral L5 spondylolysis.

During the 28 February 2003 VA Compensation and Pension (C&P) examination, the CI reported LBP began after 3 consecutive hard parachute landing falls within a 6-week time frame in 1999.  He complained of daily, waxing and waning, 4-5/10 LBP over the central lower spine.  Pain was exacerbated to 8-9/10 by running, bending, lifting, and carrying and relieved by lying down and medications.  The physical examination documented a normal gait (toes, heels, and tandem walk) and posture.  The spine examination revealed no deformity, abnormal contour (kyphosis, lordosis, or scoliosis), swelling, redness, paraspinal muscle spasms, or tenderness.  “A full range of motion is evident in most joints except [knees] as indicated later.”  Strength, sensation, deep tendon reflexes, and pulses were normal and pathologic reflexes were absent.  The examiner recounted the MRI findings.  The diagnosis listed mechanical LBP secondary to bilateral L5 spondylolysis.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, analogously coded 5295 (lumbosacral strain) citing painful motion.  The VA also rated the low back condition 10%, also coded 5295 based on the VA C&P examination 2 months before separation, citing characteristic painful or limited motion.  

In accordance with DoDI 6040.44, the Board is required to recommend a rating IAW the VASRD in effect at the time of separation, which was the 2003 VASRD standards for the spine.  There was no vertebral fracture (5285), complete spine ankylosis (5286), lumbar spine ankylosis (5289), or sacro-iliac injury/weakness (5294) for consideration under the respective codes.  There was no neuropathy, characteristic pain, muscle spasm, absent deep tendon reflex, neurological findings appropriate to disc site, or recurring attacks for consideration under intervertebral disc syndrome (5293).  Board members agreed a 10% rating was supported under lumbosacral strain (5295) based on characteristic pain on motion.  Board members agreed that the ROM values more closely approximated the slight (10%) than the moderate (20%) rating under lumbar spine limitation of motion (5292).  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 low back condition.
Contended PEB Condition:  Stage 2B nodular Hodgkin Lymphoma.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement and was not judged to fail retention standards.  The contended condition was reviewed and considered by the Board.  There was no performance based evidence from the record that this condition significantly interfered with satisfactory duty performance.  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 Stage 2B nodular Hodgkin lymphoma condition and so no additional disability rating is recommended.

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.  In the matter of the contended stage 2B nodular Hodgkin lymphoma condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  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 20140715, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160017222 (PD201403761)

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
(  ) DVA