RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00804
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040927

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

CI CONTENTION:  The CI requests a review of all 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 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 - 20040818	VARD - 20080806	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Subjective Back Pain, without Neurologic Abnormality	5299- 5237	10%	Chronic Low Back Strain	5237	10%	20080421	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in 1991 after heavy lifting.  She was ultimately referred to the Disability Evaluation System and medically separated from the Army in 1992 for the same back condition.  Following re-enlistment, her pain returned in August 2001 without any specific injury or trauma.  X-rays from 2001 and 2003 did not reveal degenerative joint disease.  A bone scan in 2002 found no lumbar findings.  Despite treatment, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and she was referred for an MEB.  The MEB forwarded “chronic low back pain” for PEB adjudication.  

During the 27 May 2004 MEB examination (recorded on DD Forms 2807 and 2808), 4 months prior to separation, the CI reported back pain that began in 2001.  Physical examination revealed that her thoracolumbar range of motion (ROM) was limited to 70 degrees flexion. The CI displayed a normal gait, no para spinal muscle tenderness, normal reflexes, normal strength, normal sensation, and examination maneuvers for radicular signs were negative.  The MEB NARSUM examination was on 25 June 2004, 3 months prior to separation.  Physical examination revealed that her thoracolumbar ROM was limited to 45 degrees flexion with marginal pain as recorded in the chart.  The CI displayed a normal gait, reflexes, strength, and sensation and examination maneuvers for radicular signs were negative.  At the time of the physical therapy (PT) appointment on 3 August 2004, 2 months prior to separation, the CI reported low back pain.  On examination ROM for thoracolumbar flexion was 75 degrees following repetition.  The CI was also noted to be able to bend over while standing to remove her boots.  This documented trunk flexion as the ability to reach the top of the CI’s boots which is a functional reach of fingers between mid-shin and ankles (approximately 8‐12” above the floor and equates to ~70‐80 degrees).  At the 21 April 2008 VA Compensation and Pension (C&P) evaluation, performed 4 years after separation, the CI reported increased daily low back pain symptoms associated with activities that require heavy lifting or repetitive bending or twisting at the waist.  Physical examination revealed ROM for thoracolumbar flexion of 60 degrees following repetition.  The CI displayed a normal gait and spinal contour, no para spinal muscle spasm, no tenderness, normal reflexes and strength, and examination maneuvers for radicular signs were positive on the right.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded as 5237 (lumbosacral strain), citing limitation of motion by pain with likely application of the US Army Physical Disability Agency (USAPDA) Pain Policy.  The VA also rated the back condition 10% coded 5237 based on the VA C&P examination 4 years after separation, citing a forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees and/or painful or limited motion of a major joint or group of minor joints.  The ROM values reported by the NARSUM examiner (3 months prior to separation) are significantly worse than those reported by the MEB 2808 examiner (4 months before separation) and the detailed PT examination (2 months before separation).  There was no record of recurrent injury or other development in explanation of the more marked impairment reflected by the NARSUM measurements.  While ROM limitations may have fluctuated over time, there was no evidence in the record from which to conclude that the severity at separation approached that portrayed by the NARSUM measurements.  Members agreed that the MEB 2808 and PT examinations were more consistent with the STR.  The Board therefore placed more probative value on the MEB 2808 and PT examination measurements. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) reported on the MEB 2808 and the PT examinations both within 4 months of separation.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  The Board therefore concluded that there was insufficient cause to recommend a change in the PEB adjudication for the back condition.  

BOARD FINDINGS:  In the matter of the back 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/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, AR20170000098  (PD201500804)

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