RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00327
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030423

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

CI CONTENTION:  Her condition continues to worsen and impact daily activities.  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 - 20030213	VARD - 20031031	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5295	10%	Lumbosacral Strain	5237*	10%	20030616 & 20030616	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	
*VARD indicated code 5237 typed with hand written line-through and code 5295.  

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic low back pain condition began in December 2001 after performing M2 .50 caliber machine gun range duties.  The CI denied any specific injury or trauma.  Diagnostic imaging (X-ray) in January 2002 were normal, and MRI in June 2002 showed degenerative disc disease at L4-L5 without narrowing of the neuroforamina (space through which the spinal nerve root passes).  There were bulging intervertebral discs at L4-L5 with flattening of the ventral aspect of the thecal sac, but without narrowing of the neuroforamina.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “low back pain” for PEB adjudication.  

During the MEB examination dated 24 January 2003, 3 months prior to separation, the CI reported non-radiating, persistent back pain with non-radiating pain along the beltline.  The pain was relieved by anti-inflammatory medication.  The pain prevented her from performing her military duties and completing the physical fitness test.  Physical examination showed normal gait, reflexes, and sensation.  Provocative maneuvers for sacroiliac and hip joint pain were negative.  There was tenderness to palpation in the paraspinals area.  The examiner was silent regarding range of motion (ROM) measurements.  

At a chiropractic evaluation in March 2003, performed 1 month after separation, the CI complained of back pain radiating into both legs.  ROMs were flexion of 40 degrees, extension to 10 degrees, and lateral flexion to 10 degrees bilaterally, and rotations 20 degrees bilaterally, all limited due to pregnancy.  Provocative testing was positive for bilateral radiating leg pain.  

At the 16 June 2003 VA Compensation and Pension (C&P) evaluation, performed 2 months after separation, the CI reported intermittent lumbar discomfort rated 10/10, with occasional radiation to her left heel.  The pain was aggravated by prolonged walking, standing, sitting, or lying down.  The pain was relieved by medication (Tylenol).  Physical examination showed normal posture, gait, and strength.  Straight leg raise (SLR) testing was negative for radiating symptoms.  The ROM was mildly limited with pain to flexion of 80 degrees, extension to 5 degrees, and lateral flexion to 25 degrees bilaterally.  

During the 17 October 2003 VA Compensation and Pension (C&P) evaluation, performed 6 months after separation, the CI reported almost daily lower back pain, rated 2/10.  The pain was relieved by chiropractic treatment and medication (Tylenol).  The pain was aggravated by prolonged standing, sitting, and sleeping on her abdomen.  X-ray showed no acute fracture or dislocation.  Physical examination showed no tenderness and normal reflexes.  Straight leg raise testing was negative for radiating symptoms.  The ROM was mildly limited by pain with flexion of 90 degrees, extension to 25 degrees, and lateral flexion to 30 degrees bilaterally.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic low back pain condition 10%, coded 5299-5295 (lumbosacral strain), citing painful motion.  The VA also rated the chronic low back pain condition 10% coded 5237 (or 5295 as hand-written; either being lumbosacral strain), based on the VA C&P examinations 2 months and 6 months after separation, citing slight limited painful motion.  (NOTE:  VASRD code 5295 is prior to the 26 September 2003 VASRD revision, when lumbosacral strain changed to 5237 with new rating criteria).

All examinations in evidence documented painful motion.  All examinations except for the single post-separation chiropractic examination showed slight limited ROMs, while the greater limitation at the chiropractic examination was attributed to pregnancy by the examiner.  The Board agreed a 10% rating was justified for the presence of painful motion.  There was no evidence of moderate limitation of motion or vertebral fracture, thus the next higher 20% rating was not justified on this basis.  

The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI reported intermittent radiating pain to her legs and feet; however, examinations indicated normal strength, reflexes, gait, and sensory examinations.  There was no evidence in this case that 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 low back pain condition.  

BOARD FINDINGS:  In the matter of the chronic 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 20150523, with attachments
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

20 DEC 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160018681 (PD201500327)

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