RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00923
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071011

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

CI CONTENTION:  The CI contends all conditions.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20070702	VARD - 20080721	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5299-5237	10%	Lumbar Osteoarthritis and Degenerative Disc Disease	5242	10%	20080407	
S/P Left Kidney Donation	Not Unfitting	Residuals, Kidney Removal	7500	NSC	20080407	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to the service treatment records the CI first sought treatment for low back pain (LBP) in October 2006.  The Medical Evaluation Board (MEB) narrative summary (NARSUM), indicated the CI had several year history of LBP but symptoms increased over previous 8 months which coincided with her kidney donation in May 2006.  Lumbosacral spine X-rays were normal and magnetic resonance imaging showed spinal arthritis.  The April 2007 Orthopedic evaluation diagnosed spinal arthritis and degenerative disc disease.  No surgery was recommended.  

The MEB Orthopedic NARSUM examination on 10 May 2007, 5 months prior to separation, noted complaints of LBP with occasional radiation to the right thigh, without bowel or bladder problems.  The CI reported the LBP was aggravated by impact activity, lifting, bending or wearing load bearing equipment.  Physical examination showed a non-antalgic gait.  There were no abnormal spinal contours noted.  There was diffuse lumbar tenderness without spasm.  Thoracolumbar range of motion (ROM) was flexion of 90 degrees (normal 90) and combined ROM of 185 degrees (normal 240), with painful motion.  The CI was able to walk on her heels and toes without difficulty.  On 30 May 2007, an addendum to the NARSUM in response to the PEB’s request for additional information reported thoracolumbar ROM of flexion 90 degrees and combined ROM of 225 degrees, with the remainder of the physical examination the same as noted on 10 May 2007.  The MEB NARSUM examiner noted the CI was on pain medication three times per week for pain.  

At the 7 April 2008 VA Compensation and Pension (C&P) evaluation, 6 months after separation, the CI reported LBP with intermittent “spasms, occasionally associated with pain down the right lower extremity (RLE) and not more than 2 days of total or “near” total incapacitation in the last year.”  She denied weakness or numbness of the RLE or other neurological problems.  She had a new prescription for pain medication, but was not on any medication at the time of the VA examination.  The CI also reported numbness and tingling in the left anterior thigh following surgery for donation of her left kidney, without muscle weakness and with no effect on her activities.  Physical examination showed a “slow” gait, without difficulty getting on an off the examination table.  There were four non-tender scars on the abdomen from the kidney donation procedure.  There was no tenderness or muscle spasm over the spine.  Back ROM was flexion 80 degrees with three repetitions.  All other back ROM was normal, but the CI did not perform repetitive motion because it had caused her back to be “worse” when performed for flexion.  Painful motion was noted.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP condition 10%, coded 5299-5237 (analogous to lumbosacral strain), citing limitation of combined ROM.  The VA also rated the low back condition 10% coded 5242 (degenerative arthritis of the spine), based on the VA C&P examination 6 months after separation, citing limitation of forward flexion.  The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) and combined ROM (greater than 120 degrees but not greater than 235 degrees) reported on the MEB NARSUM and VA examinations.  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.  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).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the LBP condition.  

Contended PEB Condition:  Left Kidney Donation.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended left kidney donation condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the low back pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended left kidney donation condition, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150605, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170007299, XXXXXXXXXXXXXXXXXX. 

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,