RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04224
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050311

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E4, Motor Transport Operator, medically separated for “chronic low back pain,” with a disability rating of 10%.

CI CONTENTION:  The CI made no specific contention in the application.  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 – 20050113	VARD – 20060731	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain…	5243	10%	Lower Back Condition…	5237	NSC	20060510	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back pain (LBP) began in June 2003 after falling off a truck.  Diagnostic studies performed in June 2004 revealed a single level disc herniation of the lumbosacral spine associated with L5-S1 nerve root compression.  Orthopedics determined that surgery was not indicated.  Despite conservative treatment, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred to an MEB.  The MEB forwarded “chronic LBP,” “herniated disc at L5-S1” and “left sacroiliac joint dysfunction” for PEB adjudication.

During the MEB NARSUM examination on 27 October 2004 (4 months prior to separation), the CI complained of back pain with cramping to the left lower extremity but denied weakness, bowel, and bladder dysfunction.  Physical therapy (PT) and non-steroidal anti-inflammatory drugs provided pain relief.  Physical examination (PE) revealed a normal gait and mild tenderness about the lower spine.  Bilateral lower extremity distal neurologic testing as well as provocative maneuvers for evaluating nerve root impingement were negative.

At the time of the orthopedic clinic appointment on 25 April 2006 (13 months after separation), the CI reported he had not seen a physician since being discharged, and that he had an occasional backache and no symptoms in his left leg.  The examiner noted “lumbar, lower extremities – negative exam,” with “full motion” and normal neurological findings.  Radiologic studies were negative.  (This was a re-enlistment examination for the Navy; the CI was accepted for enlistment with a waiver and served for 3 years).

At the 10 May 2006 VA Compensation and Pension (C&P) evaluation, performed 14 months after separation, the CI reported no pain, stiffness, or weakness from the back condition.  There was no effect on activities of daily living, no functional impairment, and no impact on or lost time from work.  A PE noted “no evidence of radiating pain on movement” and no ankyloses (abnormal stiffening and immobility).  Provocative tests for nerve root impingement were negative bilaterally.  Gross examination of the spine and associated muscles were normal.  Neurologic examination and repeat spinal X-rays were normal.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP at 10% coded 5243 (intervertebral disc syndrome), citing the presence of mild tenderness.  The VA determined the back was not service connected (NSC) and assigned code 5237 (lumbosacral strain), based on the VA C&P examination 14 months after separation, citing lack of evidence for the claimed condition.  

Although there was insufficient limitation of motion to support a minimum rating, the Board agreed a 10% rating was justified for the presence of tenderness as reported on the NARSUM examination.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes which would provide for a higher rating under that formula, 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 concluded that there was insufficient cause to recommend a change in the PEB adjudication for the chronic LBP.  

BOARD FINDINGS:  In the matter of the chronic LBP 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 20141029, 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 XXXXXXXXXX, AR20160011486 (PD201404224)

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