RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00520
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060216

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Unit Supply Specialist, medically separated for “chronic low back pain [LBP],” with a disability rating of 10%.  

CI CONTENTION:  “Review 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 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 - 20051028	VARD - 20060925	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP	5299-5237	10%	Lumbar Strain	5237	0%	20060729	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY: 

LBP.  According to the service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s LBP began in November 2002, without any specific injury or trauma.  Radiographic studies showed no significant findings.  At the primary care visit on 22 August 2005, the CI reported that back pain affected her ability to ruck, lift heavy objects, run, or bend forward.  The examiner noted that the back pain was mainly in the left lower back, without spasm or radiation to the legs.  On examination, the CI’s gait, spinal contour, motor strength, reflexes, and sensation were all normal.  She had full range of motion (ROM), but pain was elicited by motion in the thoracolumbar spine.  There was some tenderness in the lumbosacral spine.  Tests for radicular signs were negative.  Despite all treatment efforts, the back condition did not improve adequately to meet the physical requirements of the CI’s military specialty and she underwent an MEB.  The MEB forwarded “chronic low back pain” for PEB adjudication.  
At the MEB NARSUM examination 16 September 2005, 5 months prior to separation, there was pain with motion of the lower back.  The CI had normal motor strength, and testing for radicular signs was negative.  The remainder of the MEB examination was normal.  During a physical therapy session 4 days later, her thoracolumbar forward flexion was 55 degrees (normal 90) and her combined thoracolumbar ROM was 185 degrees (normal 240).

At the 29 July 2006 VA Compensation and Pension (C&P) evaluation, 5 months after separation, the CI reported back pain associated with standing, and it was relieved by rest. Physical examination (PE) showed no tenderness of the paravertebral muscles of the low back. The CI had normal gait, spinal contour, reflexes, sensation, and muscle strength.  The examination maneuvers for radicular signs were negative.  Thoracolumbar ROM was normal, and was not associated with painful motion.  

The Board directed attention to its rating recommendation based on the evidence.  The Army PEB rated the back condition 10%, coded 5299-5237 (analogous to lumbosacral strain).  The VA rated the back condition 0%, coded 5237, based on the July 2006 C&P examination, 5 months after the date of separation (DOS).  

The CI’s back condition clearly improved during the 10-month period from September 2005 to July 2006.  Her thoracolumbar forward flexion improved from 55 degrees to 90 degrees (normal), and her combined thoracolumbar ROM went from 175 degrees to 240 degrees (normal).  The CI separated from service on 16 February 2006, in the middle of this 10-month period. Unfortunately, no PE of the back was done at the time of separation.  The Board determined that it was more likely than not that at the DOS, the CI’s forward flexion was greater than 60 degrees, but not greater than 85 degrees.  It was also more likely than not that at the DOS, the combined thoracolumbar ROM was greater than 120 degrees, but not greater than 235 degrees.  

Therefore, the Board agreed that a 10% rating, but no higher, was justified for limitation of thoracolumbar motion, IAW the VASRD §4.71a General Rating Formula for Diseases and Injuries of the Spine.  There was no muscle spasm or guarding severe enough to result in abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was insufficient evidence of intervertebral disc syndrome (IVDS) with incapacitating episodes, which would provide for a higher rating under the formula that condition.  There was also insufficient evidence of peripheral nerve impairment which would provide for additional rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication for the unfitting LBP condition.

BOARD FINDINGS:  In the matter of the LBP 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 20140725, 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

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160018740 (PD201500520)

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