RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04120
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040723

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve O3 (Registered Nurse) medically separated for chronic low back pain (LBP) diagnosed as sacroilitis, rated 10%.

CI CONTENTION:  Her back condition continues to worsen.  She was not evaluated for plantar fasciitis.  Her 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 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 condition 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 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 IPEB – Dated 20040405	VA* - (~4 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP…Sacroilitis	5237	10%	Sacroilitis	5236	10%	20040429	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 0	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20040802 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Low Back Pain (subsumes Sacroilitis).  The service treatment record (STR) indicated that the CI insidiously developed LBP in March 2002 and first sought medical care in June 2002.  Initially, she was diagnosed with mechanical LBP and sacroiliac joint dysfunction and referred to physical therapy.  A bone scan performed in April 2003 definitively revealed mild bilateral sacroilitis (left>right) without fracture.  She was followed by rheumatology and pain management.  Despite a variety of conservative treatments to include physical therapy, rehabilitation therapy, manipulations, injections, supports, medications, and restrictions, her local LBP continued.  She was permanently profiled in October 2003 and referred to a Medical Evaluation Board (MEB).  The MEB narrative summary (NARSUM) (15 January 2004; 6 months pre-separation) indicated that the CI could no longer run or perform repetitive jumping, stooping, or overhead activities.  The physical examination (PE) revealed a slightly antalgic gait, lumbar muscle spasm, and decreased movement of the pelvis.  A specific test for sacroiliac dysfunction was positive on the left hip.  Neuro-sensory parameters about the low back and lower extremities were normal or intact.  There was no comment IRT active range-of-motion (ROM) of the thoracolumbar spine.  Six weeks prior to the MEB NARSUM examination, the CI had ROM measurements of the thoracolumbar spine which indicated super-normal ranges across all six planes of motion.

At the VA Compensation and Pension (C&P) examination (29 April 2004; 3 months pre-separation), the CI reported constant LBP with worsening intensity with vigorous physical activities or with prolonged sitting.  Her PE was detailed and completely normal.  Again, her ROM’s were all in super-normal range.  Her diagnosis remained as chronic LBP due to bilateral (left>right) mild sacroiliitis.

The Board directed attention to its rating recommendation based on the above evidence.  Both the PEB and VA rated the back condition at 10% citing painful motion and utilized similar primary codes of 5237 (Lumbosacral strain) and 5236 (Sacroiliac injury).  Board members deliberated and agreed that the normal physical exam findings at 3 months prior to separation clearly would not support any VASRD impairment rating greater than the PEB’s current 10%.  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 low back pain.

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

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 AR20160004461  (PD201404120)

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 1O, 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