RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00125
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20020605

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Signal Support Systems, medically separated for “chronic low back pain” with a 10% disability rating.

CI CONTENTION:  Contends her back condition and several other conditions.  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 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 - 20020422	VARD - 20020802	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5293	10%	Degenerative Disc Disease, Lumbar	5295-5293	20%	20020610	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:

Low Back Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back pain (LBP) began in May 2001 while doing flutter kicks.  She said the pain was sharp, and radiated down her left leg.  X-rays showed grade I spondylolisthesis and spondylolysis of L5-S1.  Electromyogram (EMG) in July 2001 was negative.  Magnetic resonance imaging (MRI) on 6 July 2001 showed disc desiccation at L4-5 and L5-S1, with spondylolisthesis of L5 on S1 noted.  There was bilateral foraminal narrowing.  The CI had 3 months course of physical therapy, and was then evaluated by a neurosurgeon.  The examiner offered surgical spinal fusion, but the CI declined surgery.  Despite all treatment efforts, the back condition did not improve adequately to meet the physical requirements of the CI’s military specialty.  The MEB forwarded chronic low back pain with herniated nucleus pulposus and spondylolisthesis and spondylolysis of L5-S1 with frequent frequency and slight intensity to the PEB for adjudication.

The MEB NARSUM examination dated 06 March 2002 (3 months before separation) noted complaints of constant low back pain with posterior lower extremity pain aggravated by sitting, standing, running or flutter kicks.  Her pain was sometimes eased with stretching out, wearing a back brace, or medicine (NSAIDs, muscle relaxants or narcotics).  She reported 24-hour pain which was worse at end of day and at night.  Physical examination revealed range of motion (ROM) of flexion 80 degrees (normal 90) with painful motion not addressed.

The 10 June 2002 VA Compensation and Pension (C&P) evaluation, performed 5 days after separation, noted complaints of excruciating low back pain radiating down her left calf and into her toes.  Flares interfered with her activities of daily living.  Physical examination showed a positive left straight leg raise, and spinal muscle spasm and tenderness.  The ROM was flexion of 70 degrees and combined ROM of 195 degrees (normal 195) with painful motion not addressed.  No additional loss of ROM, pain, weakness, incoordination or lack of endurance due to repetition.

The Board directed attention to its rating recommendation based on the evidence.  The PEB rated the low back pain at 10%, coded 5293 (intervertebral disc syndrome).  The VA rated the low back condition 20%, analogously coded 5295-5293 (lumbosacral strain, with intervertebral disc syndrome), citing limitation of motion and muscle spasm.  The spine coding and rating standards in effect at the time of the CI’s separation was the 2002 VASRRD.  The Board agreed that a 10% rating was supported by the MEB NARSUM and VA examinations for a “slight” limitation of spine motion coded 5292.  There was no muscle spasm on extreme forward bending, loss of lateral spine motion, unilateral, in standing position to support the 20% rating.  There was no vertebral fracture (5285), complete spine ankylosis (5286), lumbar spine ankylosis (5289), sacroiliac injury/weakness (5294), or lumbosacral strain (5295) for consideration under the respective codes.  However, the Board agreed that there was sufficient  STR and VA evidence that showed the CI experienced “moderate, recurring attacks” which support a 20% rating coded 5292 (intervertebral disc syndrome).  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 5293.  

BOARD FINDINGS:  In the matter of the chronic low back pain condition, the Board unanimously recommends a disability rating of 20%, coded 5293 IAW VASRD §4.71a.  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	5293	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150126, 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

08 DEC 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160018480 (PD201500125)

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