RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03930
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070507

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Financial Technician, medically separated for “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 on 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 - 20070308	VARD - 20071009	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Mechanical Low Back Pain	5237	20%	20070730	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain Diagnosis.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in February 2006 after the CI sustained an injury during the sit-ups event of the APFT.  The CI reported that his back seized up and there was instant pain.  Radiographic studies from July 2006 to January 2007 were normal.  The CI was treated with physical therapy, rest, anti-inflammatory medication, and chiropractic treatments.  In 2006, the CI went to a civilian Chiropractor who conducted radiographic studies and told the CI he had scoliosis.  The CI underwent a “lower back adjustment” with some temporary improvement in his pain.  It was determined the adjustments would only provide temporary benefit and the CI was referred to the MEB.  The MEB forwarded “chronic lower back pain” for PEB adjudication.  

At the MEB examination in December 2006, 5 months prior to separation, the CI reported muscle spasms and a locking sensation in his back.  The CI reported one emergency room visit for back spasm in which he was treated and released.  Physical examination showed mild tenderness to palpation over the lumbar vertebral bodies. There was no evidence of muscle spasm and straight leg raise testing was negative for radiculopathy.  The MEB NARSUM examination on 6 December 2006, 5 months prior to separation, noted complaints of chronic back pain.  Physical examination showed no bony abnormality, straight leg raise testing was negative, strength and sensation in the lower extremities were normal, and inorganic pain sign test was negative.  The thoracolumbar ROM (range of motion) was flexion 60 degreed (normal 90), extension 20 degrees (normal 30).  Other planes of motion were beyond the normal range. At the 30 July 2007 VA Compensation and Pension (C&P) evaluation, performed 10 months after separation, the CI reported persistent low back pain.  Pain was reported as varying in intensity with associated back muscle spasms.  No radicular pain or incapacitating episodes were reported.  The CI reported wearing a back brace on occasion.  No weakness, fatigability, decreased endurance and coordination, or flare-ups were reported.  Physical examination showed normal posture and gait with no appreciable scoliosis noted. There was no tenderness to palpation, but pain with repetitive forward flexion was noted.  The thoracolumbar ROM was flexion 40 degreed (normal 90); extension and right and left lateral rotation were 20 degrees (normal 30).  Other planes of motion were beyond the normal range.  Radiographic studies remained normal. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5237 (lumbosacral or cervical strain), citing motion limited by pain, tenderness to palpation, no spasm or deformity.  The VA rated the back condition 20% coded 5237 (lumbosacral or cervical strain), based on the VA C&P examination 10 months after separation, citing forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees.  The Board agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees) reported on the NARSUM and VA C&P examinations.  There was no documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes which would provide for a higher rating under that formula (for IVDS), or evidence of ratable peripheral nerve impairment which would provide for additional rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the back condition, coded 5237.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that hyperlipidemia condition was not unfitting.  The condition was not profiled, implicated in the commander’s statement or was not judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for contended hyperlipidemia condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the back condition, the Board unanimously recommends a disability rating of 20%, coded 5237 IAW VASRD §4.71a.  In the matter of the contended hyperlipidemia 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 recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Low Back Pain	5237	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140805, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB										

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

02 DEC 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160017868  (PD201403930)

1.  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, accept the Board’s recommendation to modify the individual’s disability rating to 20% without re-characterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA