RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00888
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20091004

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Food Service Specialist, medically separated for “chronic low back pain [LBP] secondary to intervertebral disc syndrome [IDS],” with a disability rating of 20%.

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 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 - 20090519	VARD - 20100415	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP secondary to IDS	5243	20%	Degenerative Joint and Disc Disease of the Lumbar Spine	5243	10%	20100310	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic LBP Secondary to IDS.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back condition began in September 2005 after falling.  Radiographic studies in October 2008, showed a disc protrusion that appeared to touch the S1 nerve root.  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 an MEB.  The MEB forwarded chronic LBP for PEB adjudication.  At the time of the orthopedic clinic appointment on 22 January 2009, the CI complained of radiating pain down the left side of the body to the mid-thigh.  Physical examination revealed the CI did not display any muscle spasms and was tender to palpation in the lumbar vertebral and paraspinal muscles.  Range of motion (ROM) obtained noted 10 degrees forward flexion (normal 90), and 5 degrees of extension (normal 30).  At a follow-up orthopedic appointment on 25 March 2009, the CI reported complaints of constant pain, particularly when urinating that rated 7/10 in severity.  On examination the back was tender to palpation, and there was no evidence of radiculopathy, or muscle spasms.  The MEB NARSUM examination on 3 March 2009 (7 months prior to separation) noted complaints of pain.  Physical examination showed normal neurological and spine exams.  Physical therapy (PT) ROM recordings for the MEB, dated 6 months before separation, documented forward flexion to average of 31 degrees and extension to 8 degrees on average of three trials, with pain and stiffness as limiting factors.  At the 10 February 2010 VA Compensation and Pension (C&P) evaluation, performed 4 months after separation, the CI reported shooting pains from the left buttock to the foot and toes.  The CI could walk 1/2 mile and required frequent breaks to stretch the back after prolonged standing.  Physical examination revealed an antalgic gait, no guarding of movements, no spasms and a normal spinal curvature.  Motor and sensory functions were normal.  The flexion ROM measured 70 degrees and she had 20 degrees of extension.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 20%, coded 5243 (IVDS), citing decreased ROM of forward flexion to 35 degrees.  The VA rated the low back condition 10% coded 5243, based on the VA C&P examination 4 months after separation, citing decreased ROM of forward flexion to 70 degrees.  The Board agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees).  The Board noted that one out of three ROMs recorded at the MEB ROM PT met the threshold for a 40% rating; however, given that two of the measurements were greater than 30 degrees, Board members concluded the 40% rating was not justified.  Additionally, the VA examination was more proximate to separation and conveyed significantly different ROM, from the MEB measurements, likely due to an improvement in her condition.  The Board also  considered whether a higher rating (§4.7) was achieved by using the alternate rating formula based on incapacitating episodes due to intervertebral disc syndrome (IVDS).  Although the CI was adjudicated as having back pain secondary to intervertebral disc syndrome by the PEB, there were no incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula (for IVDS).  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 LBP secondary to IDS condition and IAW VASRD §4.71a, the Board 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 20140902, 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, AR20170000820 (PD201500888)

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