RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00063
BRANCH OF SERVICE: Army	SEPARATION DATE:  20011118

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Small Arms Repairer, medically separated for “chronic mechanical low back pain [LBP],” 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 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 - 20010816	VARD - 20021001	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Mechanical LBP	5295	10%	Lumbosacral Strain	5295	10%	20020812	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Mechanical LBP.  According to service treatment records (STRs) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back condition began in October 2000 after a rucksack march and she had persistent midline low back pain thereafter.  A note dated 1 November 2000 indicated the CI had back pain for 2 days after pulling a tent while folding it when suddenly pain began; and she then dragged the tent by herself.  Treatment consisted of Valium (diazepam, a muscle relaxer) and Motrin (ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), and a profile.  An X-ray series dated 29 November 2000 ordered for years of spinal pain, which was acute from a ruck march 3 weeks earlier, demonstrated insignificant scoliosis of the thoracic spine and slight posterior settling of L5 on S1 with slight compromise of the L5-S1 disc space.  A very minor insignificant lumbar scoliosis was noted and the SI (sacroiliac) and hip joints were normal.  In February 2001 she had tenderness to palpation in the L5-S1 area muscles and had forward flexion of her hands to the floor.  At an examination in March 2001 she had a full range of motion (ROM), a normal gait, and normal strength, while at a physical therapy visit she had a full active ROM of the lumbar spine with very tight hamstring muscles bilaterally with tenderness of the paravertebral muscles bilaterally in the mid thoracic and lumbar areas.  Her gait was normal as was her strength.  In May 2001 she reported some improvement with the lumbar stabilization educational program until she rode in the back of a truck.  Throughout the course of treatment she denied any night pain, numbness, tingling, radicular pain, or bowel, bladder or urinary incontinence.

Despite numerous courses of rest and treatment with NSAIDs as well as physical therapy and chiropractic treatment, the CI’s back condition was not significantly improved and she could not be adequately rehabilitated to meet the physical requirements of her military specialty.  She was referred for MEB and the MEB forwarded “mechanical back pain” for PEB adjudication.

At the NARSUM examination dated 6 June 2001, 5 months prior to separation, she was able to forward flex with her hands approximately 5 inches from the floor.  She had full extension and right and left lateral bending without difficulty.  She was minimally tender along the lumbar spine on the paraspinous muscles from L1 to T12.  She had a negative straight leg raise (to determine nerve root irritation) in both sitting and standing.  Neurologic evaluation was unremarkable with normal sensation, reflexes, and motor strength in the lower extremities.  She was able to do toe raises bilaterally and walk on her heels and toes without difficulty.  Faber’s testing (to determine hip pathology) was negative bilaterally.  Her back was without spasm at the time of the examination, although in an undated letter she noted she had back spasms due to her back being injured.  At the MEB examination performed on 6 June 2001 and 26 June 2001 approximately 5 months prior to separation, the CI reported “chronic back pain, unrelievable and recurrent.”  The examiner checked normal spine for the clinical evaluation.

At the VA Compensation and Pension (C&P) examination in August 2002, performed 9 months after separation, the CI reported low back pain.  On examination her carriage, posture, and gait were normal.  The lumbosacral spine was in the midline.  No tenderness or spasms were noted.  The ROM measurements were forward bending 65 degrees with pain across the lower back, lateral bending left and right 38 degrees with no associated pain, rotation left and right 30 degrees with no associated pain, and extension 30 degrees with no pain.  With repetition there was no increase of pain, no further decrease in motion, no weakness, and no impaired endurance.  Straight leg raising in both sitting and supine positions was negative bilaterally.

The ROM examinations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.  

Thoracolumbar ROM
(Degrees)	MEB ~5 Mo. Pre-Sep
	VA C&P ~9 Mo. Post-Sep
	
Flexion (90 Normal)	Hands 5” from floor	65	
Combined (240)	-	215	
Comment	Tenderness paraspinous muscles L1-T12	Pain across the lower back with flexion	
§4.71a Rating	PEB 10%	VA 10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 5295 code (lumbosacral strain), citing chronic mechanical low back pain since “heavy ruck march October 00,” without significant relief from conservative care.  The VA also assigned a 10% rating using the 5295 code based on the VA C&P examination 9 months after separation, citing lumbosacral strain.  Although not reported as goniometric measurements, the MEB NARSUM examination of forward flexion was hands 5 inches from the floor, which is similar to a full ROM of 90 degrees, while the VA C&P examination, 9 months post-separation, the flexion measurement was 65 degrees.  At neither examination was there objective muscle spasm.  To warrant a 20% rating using code 5295 requires “with muscle spasm on extreme forward bending, loss of lateral spine motion, unilateral, in standing position.”  The CI did not have those findings nor was her condition severe.  The CI did not have findings, sciatic pain, or recurrent attacks consistent with the intervertebral disc syndrome (code 5293) nor was there any evidence of ankylosis (codes 5286, 5288, or 5289), and there was no limitation of motion of the lumbar spine (code 5292) prior to separation, while at the VA examination, 9 months after separation, the limitation of motion did not rise to the moderate level.  The Board also considered whether an additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI reported no radiating pain, numbness, tingling or bowel or bladder dysfunction and had unremarkable neurologic examinations.  Therefore, the critical decision is whether or not there was a significant motor weakness which would impact military occupation-specific activities.  There was no evidence in this case that a sensory deficit or motor weakness existed to any degree that could be described as functionally impairing.  The Board, therefore, concluded that an additional disability rating was not justified on this basis.  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 mechanical low back pain condition.  

BOARD FINDINGS:  In the matter of the chronic mechanical low back pain 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 20150115, 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 
XXXXXXXXXXXXXXXXXX, AR20160018839 (PD201500063)

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