RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD -2014-03877
BRANCH OF SERVICE:  Army	Separation Date:  20040201

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard, E5, Military Policeman, medically separated for “chronic 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 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 - 20031218	VARD - 20040813 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5243	10%	Lumbosacral Strain	5237	10%	20040831	
COMBINED RATING:  10%	COMBINED RATING FOR ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Back Pain.  The CI injured his lower back in April 2003.  A lumbar spine X-ray done in May 2003 for reported of lower midline back pain at L3-L5 showed some straightening of lumbar lordosis, but otherwise normal exam.  In June 2003, the CI reported occasional numbness, tingling and shooting pains into his left leg.  A lumbar spine scoliosis survey X-ray done in May 2003 was negative; no finding of scoliosis curvature.  A lumbar spine magnetic resonance imaging completed in June 2003 showed a bulge of the L5-S1 disc and [possible herniation of the disc on the right].  A repeat lumbar spine X-ray done in August 2003 showed no change from the May 2003 exam.  The CI underwent two epidural steroid injections (ESI’s), the first in November 2003 and the second in December 2003 after which he reported a 50% pain reduction.  The MEB narrative summary (NARSUM) exam approximately 2 months prior to separation documented that he CI had functional limitations of an inability to perform running or jumping exercises, an inability to perform sit-ups, flutter kicks and he could only perform modified push-ups.  He reported a fairly good response to the second ESI of a reduction in pain level from 6/10 down to 1-1.5/10.  The MEB NARSUM physical exam findings are summarized in the chart below.  

The VA Compensation and Pension (C&P) exam approximately 7 months after separation documented that the CI reported chronic back pain aggravated by prolonged walking, standing, sitting, climbing or bending.  He experienced stiffness and achiness in the morning.  He denied any pain radiation into his legs. The VA C&P physical exam findings are summarized in the chart below.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the back condition as 5243 (intervertebral disc syndrome) and rated at 10%.  The VA coded the back condition as 5237 (lumbosacral strain) and rated at 10%.  Both exams in evidence would rate 10% for range of motion (ROM) limitations (forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined ROM of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees).  There was no muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour.  There was insufficient evidence of incapacitating episodes (physician–prescribed bed-rest) having a total duration of at least two weeks during the past 12 months for any higher rating under the 5243, based on incapacitating episodes.  There was no motor impairment on physical exam.  Since no evidence of functional impairment existed in this case, the Board cannot support a recommendation for additional rating based on peripheral nerve impairment.  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 condition.

BOARD FINDINGS:  In the matter of the back 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 20140825 w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

28 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 (PD201403877)

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