RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00099
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030601

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Motor Transport Operator, 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 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 - 20030407	VARD - 20040610	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5293-5299-5295	10%	Residuals Back Injury	5237	NSC	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NSC	

ANALYSIS SUMMARY:  

Low Back Pain.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in April 2002 with a gradual onset of pain.  There was no specific injury or trauma reported.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty. The MEB forwarded mild lumbar degenerative disc disease for PEB adjudication.  The MEB NARSUM examination on 11 November 2002 (7 months prior to separation) noted complaints of nearly constant low back pain that radiated to the buttocks and legs bilaterally (left greater than right) only relieved by rest and narcotic pain medication.  Physical examination showed decreased range of motion of the lumbar spine in all planes with increased pain on forward flexion.  There was tenderness and spasm of the paraspinal muscles of the lumbar region.  

At the 15 August 2004 VA Compensation and Pension (C&P) evaluation (performed 15 months after separation) the CI reported daily back pain rated 7/10 in intensity that increased with bending or twisting.  The CI also reported that he had had 10 incapacitating episodes in the previous year and that he only got relief by taking narcotic medications or rest.  Physical examination showed forward flexion to 45 degrees, extension was 0 degrees, lateral bending to the left was 5 degrees, 20 degrees to the right, all limited by pain.  Spasm was noted in the muscles around his lumbar spine.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5293-5299-5295 (lumbosacral strain), citing pain with motion. The VA rated the back condition 20% coded 5237 (lumbosacral strain), based on the VA C&P examination 15 months after separation, citing forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees or the combined range of motion of the thoracolumbar spine not greater than 120 degrees (new spine rules).  The CI complained of low back pain that began over one year prior to separation that was made worse after a back injury in May 2002.  His evaluation included normal plain film X-rays in June 2002 and an MRI (also in June 2002) that showed a broad-based disc bulge that was causing narrowing of the L4-L5 neuroforamin and pressure on the nerves bilaterally.  The CI was treated conservatively with pain medication, rest, physical therapy, and traction as well as a more aggressive approach of epidural steroid injections three times that gave little or no relief from his symptoms.  In the 12 months prior to separation, the evidence submitted shows that the CI attended a minimum of 43 back pain related clinic visits, had multiple profile renewals effectively being on continuous profile for greater than one year, and had seven separate episodes of quarters with a total accumulation of 14 days of healthcare provider prescribed rest met criteria of the  spine schedule in effect at the time of separation for incapacitating episodes totaling a minimum of 2 weeks but not exceeding 4 weeks over the preceding 12 months for a 20% rating for code 5293.  The Board also noted that the evidence supports a rating for muscle spasm with extreme bending and loss of lateral motion for a 20% rating under 5295 (lumbosacral strain).  

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 low back pain condition, coded 5293.  

BOARD FINDINGS:  In the matter of the low back pain condition, the Board unanimously or majority recommends a disability rating of 20%, coded 5293 IAW VASRD §4.71a (interim spine rules).  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	
Intervertebral disc syndrome	5293	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150201, 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, AR20160017949  (PD201500099)

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