RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00496
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20020621

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E4, Motor Transport Operator, medically separated  for “chronic lower back pain,” with a disability rating of 10%.

CI CONTENTION:  The CI made no specific contention.  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 on 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 - 20020501	VARD - 20080708	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Lower Back Pain	5293	10%	Chronic Lower Back Pain	5237	NSC	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NSC	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back condition began in December 1999 as the result of a motor vehicle accident (MVA).  Radiographs taken at the time were unremarkable.  Due to continued pain accompanied by radicular symptoms, and minimal improvement with treatment, a magnetic resonance imaging (MRI) was recommended.  In January 2001, MRI showed disk bulges at L2-L3, L3-L4, L4-L5, and L5-S1 with compression of the S1 nerve root.  Evaluation by neurosurgeon recommended non-surgical treatment.  Despite treatment, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for a MEB.  The MEB forwarded “chronic low back pain” for PEB adjudication.  

At the MEB NARSUM examination on 27 January 2002, the CI reported she has continued to have back pain from the MVA with occasional radiation into her legs accompanied by numbness and tingling.  The CI reported she was only able to lift approximately 20 pounds, unable to climb upon a truck and therefore, was unable to perform the duties of her job.  She noted that she has continued to limp when walking.  Physical examination recorded tenderness to palpation over certain paravertebral muscles; however, the presence of muscle spasm was not reported.  Range of motion (ROM) recorded forward flexion of 70 degrees (normal 90), and extension of 20 degrees (normal 30).

The Board directed its attention to its rating recommendation based on the above evidence.  The 2002 VASRD coding and rating standards for the spine, which were in effect at the time of separation, reflected changes to the 5293 code that went into effect in September 2002, 3 months after separation.  The 2002 standards for rating based on ROM impairment were subject to the rater’s opinion regarding degree of severity, whereas the current standards specify rating thresholds in degrees of ROM impairment.  The PEB rated the back condition 10%, coded 5293 (intervertebral disc syndrome), citing without neurologic abnormality.  The VA denied service connection for the chronic lower back pain, based on the VA Rating Decision 6 years after separation, citing no evidence of the existence of a condition and that the CI failed to report for a VA C&P examination.  The Board agreed that a 10% rating, but no higher, was justified for mild attacks under the 5293 code, based on the CI’s report of occasional pain radiation in the absence of clinical evidence supporting weakness and loss of neurologic functioning, and absence of back spasm during MEB NARSUM examination.  The Board noted the condition did not rise to the 20% level of under the limitation of motion code (5292).  The Board next considered the 8520 (sciatic) nerve code since the CI reported occasional radicular symptoms.  The MEB NARSUM did not describe any objective evidence of decreased sensation, vibration, or and loss of sensory function to areas represented by S1 distribution (dorsum of foot, ankle).  Additionally, ankle jerk was present and symmetrical, and gait was not recorded as abnormal.  The Board found no route to a higher rating under any applicable code.  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 low back 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 20150601, 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, AR20170002161 (PD201500496)

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