RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00392
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060107

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated Reserve E3, Automated Logistics Specialist, medically separated for “chronic low back pain,” with a disability rating of 0%.  

CI CONTENTION:  Her condition continues to impact her ability to perform 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 - 20051216	VARD - 20060607	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain 	5243	0%	Herniated Nucleus Pulposus	5243	0%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Lumbar Back Pain.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back pain (LBP) condition began in September 2005 after lifting a heavy object.  She reported associated radicular pain into her left leg.  Imaging studies revealed low lumbar disc protrusion resulting in a moderate to severe left-sided narrowing of the spinal canal.  Electro-diagnostic studies revealed no peripheral radiculopathy or neuropathy.  Despite aggressive non-surgical treatment, the CI did not achieve improvement sufficient to allow unrestricted duty and she was referred to an MEB.  The MEB forwarded “persistent LBP with herniated nucleus pulposus without radiculopathy” for PEB adjudication.
   
At the MEB NARSUM examination performed on 21 November 2005, 2 months prior to separation, the CI reported continued LBP with “intermittent tingling” of both legs.  Physical examination was detailed and completely normal.  There was no comment with regards to the presence of painful motion.  Her diagnosis remained unchanged.  Physical therapy (PT) measured lumbar range of motion (ROM) performed documented the presence of painful motion with right lateral flexion and rotation.  

There was no VA Compensation and Pension (C&P) examination, the CI did not keep her scheduled appointment on 6 January 2006; therefore, this Boards final impairment rating recommendation will be based upon clinical evaluations and MEB-driven documents contained in the case file. 

The Board directed attention to its rating recommendation based on the above evidence.  Both the PEB and VA rated the back condition at 0% utilizing VASRD code 5243 (intervertebral disc syndrome) citing the absence of spasms and ROM greater than 235 degrees by the PEB, and normal ROM by the VA.  All Board members agreed that the thoracolumbar examination performed prior to separation did support an impairment rating IAW VASRD §4.59 (painful motion) as documented by PT.  Additionally, there was no evidence of intervertebral disc syndrome (IVDS) which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula (for IVDS).  

The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  While the CI may have experienced radiating pain from the back condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  There was no objective evidence of a radiculopathy/neuropathy with functional impairment (such as weakness) that directly impacted fitness for duty.  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 recommends a disability rating of 10% for the chronic low back pain condition.

BOARD FINDINGS:  In the matter of the chronic low back pain condition, the Board unanimously recommends a disability rating of 10%, coded 5237 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 her prior medical separation: 

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Low Back Pain 	5237	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150530, w/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

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXX, AR20160018718   (PD201500392)

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 10% 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