RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXXX		CASE:  PD-2014-04208
BRANCH OF SERVICE: Army		separation date:  20021003

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, Automated Logistics Specialist, medically separated for “mechanical low back pain” with a disability rating of 10%.

CI CONTENTION:  The CI contends for all of her conditions.  The applicant’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 - 20020614	VARD - 20021009	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5295	10%	Sacroiliac Joint Syndrome and Iliac Crest Syndrome…	5299-5295	10%	20020715	
COMBINED RATING:  10%	COMBINED RATING FOR ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:

Low Back.  The service treatment records (STRs) and the Medical Evaluation Board (MEB) narrative summary (NARSUM) indicated the CI had a 5-year history of low back pain.  She first noticed locking of her back in September 1996 when she performed a physical fitness test.  Radiographic imagining (X-ray) August 1998 demonstrated mild levoscoliosis (curvature of the spine to the left) of the lumbar spine, but was otherwise unremarkable.  Besides pain in the back, she also occasionally had right sided pain that went down her right hip to her right knee, which in October 1999 was treated with toradol (an opioid-like medication).  A physical medicine evaluation in November 1999 noted tenderness over the right posterior superior iliac spine and the right piriformis muscle area.  Tests for sacroiliitis were positive on the right and her range of motion (ROM) for flexion was only 30 degrees because of pain in the right lower lumbar region.  Diagnostic studies (bone scans and MRI) of the hip, pelvis and back were all within normal limits.

At the MEB examination (recorded on DD Forms 2807) dated 29 November 2001, approximately 10 months prior to separation, the CI reported back problems of the sacrum and lower back for 5 years.  During the MEB NARSUM dated 2 April 2002, 6 months before separation, physical examination noted mildly tender at the right paraspinous muscles.  Her active ROM was normal and hip ROM was pain-free.  Her muscle strength of the lower extremities was 5/5 and sensation was intact to light touch and pinprick.  The remainder of the neurological evaluation was unremarkable.  Pain was markedly increased with running or other physical activities.  Despite rest, activity modification, physical therapy, injection and anti-inflammatory medication (Daypro, oxaprozin, an NSAID), there was not any true improvement in her symptoms.  A MEB Addendum dated 2 May 2002, 5 months before separation, noted the CI continued to have extreme difficulty with pain in her back, particularly with sitting and standing.  She was unable to sit comfortably on her right buttock and had to lean over to the right side consistently.  On examination she was able to flex forward with her hands to her knees, which evoked pain and spasm in her paraspinal muscles.  She was able to extend to approximately 20 degrees and could lateral bend 15 degree bilaterally, which was marked by pain.  She did have full rotation of her spine, but the motion was painful.  X-rays of the thoracic spine showed dorsal lumbar dextroscoliosis (curvature of the spine to the right), which may have been positional.  No significant abnormalities were otherwise identified and there were no fractures or dislocations.

At the VA Compensation and Pension (C&P) examination dated 15 July 2002, performed 3 months before separation, the CI reported low back pain started in 1995 with no specific injury.  Pain was at the 5/10 level about once a week and there was occasional radicular pain down the right leg.  At times the low back pain was attributed to right sacroiliac joint pain and along with right hip pain was worse with physical training activities.  On examination posture and gait were normal.  Flexion was 80 degrees; extension 30; and bilateral lateral motion 40.  There was tenderness over the right sacroiliac joint and right iliac crest with paraspinous muscle spasm.  Straight leg raising was positive (to determine nerve root irritation) on the right at 30 degrees and negative on the left.  A lumbosacral X-ray series suggested a bilateral pars interarticularis fracture of the L5 vertebral body, but there was no significant anterior listhesis (one vertebra forward over the lower vertebra).

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10% analogously coded 5299-5295 (lumbosacral strain), citing painful on motion.  The VA also rated the low back condition 10% analogously coded 5299-5295 based on the VA C&P examination 3 months before separation, citing sacroiliac joint syndrome and iliac crest syndrome with degenerative joint changes.  The Board noted 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.

Board members considered use of analogous code 5299-5295 at 20% which states: “With muscle spasm on extreme forward bending, loss of lateral spine motion, unilateral, in standing position” since the CI was observed to have evoked muscle spasm on forward flexion and she also had moderate bilateral limitation of lateral flexion.  The Board also considered code 5292 (lumbar limitation of motion) at 20% since the CI was only able touch her hands to her knees at the MEB Addendum examination; however, by the VA C&P examination, which was more proximate to separation, flexion was 80 degrees, which is not consistent with a moderate limitation of motion.  However, Board members noted the VA C&P examination failed to provide ROM measurements of lateral flexion and was silent on whether there was muscle spasm; whereas, the MEB Addendum provided these measurements.  No significant motor or sensory deficit was present to warrant the use of code 5293 (intervertebral disc syndrome) nor were their recurrent attacks of intervertebral disc symptoms.  Board members did note code 5294 (sacroiliac injury and weakness) partially defined her disability, but it did not offer a route to a higher rating.  There was no evidence in this case that motor weakness or a sensory deficit existed to any degree that could be described as functionally impairing.  Therefore, the Board concluded that an additional disability rating for a radiculopathy was not justified.  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 chronic low back pain condition, coded 5299-5295.

BOARD FINDINGS:  In the matter of the chronic low back pain condition, the Board majority recommends a disability rating of 20%, coded 5299-5295 IAW VASRD §4.71a.  The single voter for dissent recommended no change to the assigned rating and did not elect to submit a minority opinion.  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	5299-5295	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140822, 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

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXXX, AR20160018284 (PD201404208)

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