RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01335
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040716

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

CI CONTENTION:  “Review all conditions.”  The CI’s 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 panel 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 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 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 - 20031203	VARD – N/A	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5299-5237	10%	
No VA Examination in Evidence
	
Psoriasis	Not Unfitting		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Chronic Back Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in early 2002 without any specific injury or trauma.  Thoracic spine X-rays were normal except for a mild scoliosis.  Lumbosacral magnetic resonance imaging in March 2003 was normal.  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 low back pain” for PEB adjudication.

At the time of the orthopedic specialty consult on 7 May 2003, 14 months prior to separation, the CI reported “constant pain of 9/10 which [was] aggravated by bending, lifting or running and sit-ups.”  On examination the CI’s range of motion (ROM) was flexion of 60 degrees (normal 90) and combined ROM no less than 140 degrees (normal 240), with painful motion.  There was no tenderness.  Examination tests for radicular symptoms were negative and she had normal strength, sensation, and reflexes in her lower extremities.  
 
During the MEB examination (recorded on DD Forms 2807 and 2808) dated 12 June 2003, 13 months prior to separation, the CI reported “tingling in [her] legs.”  Physical examination showed generalized tenderness to palpation (TTP) of the thoracolumbar spine and sacroiliac joints, but no TTP or spasm of the paraspinal muscles.  Her spinal contour was normal.  Examination tests for radicular symptoms were negative and she had normal strength, sensation, and reflexes in her lower extremities. 

The MEB NARSUM examination on 12 June 2003, 13 months prior to separation, noted complaints of low back pain aggravated by any physical activity or with prolonged standing.  The MEB NARSUM cited the findings of the MEB DD Form 2808 examination.  Physical therapy ROM evaluation for the MEB was performed on 18 June 2003 and showed thoracolumbar ROM of flexion 90 degrees and combined ROM of 230 degrees.  There were no VA documents in record because the CI did not file a claim with the VA.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5299-5237 (analogous to lumbosacral strain).  The Board agreed that a 10% rating, but no higher, was justified for limitation of combined ROM greater than 120 degrees but not greater than 235 degrees reported on the physical therapy ROM study.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour noted at examinations in the STR, the MEB orthopedic examination or the PT MEB evaluation, thus the next higher 20% rating was not justified on this basis.  There was no documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes which would provide for a higher rating under that formula (for IVDS), or evidence of ratable peripheral nerve impairment which would provide for additional rating.  Although the ROM noted at the earlier orthopedic examination is consistent with a 20% rating, the Board placed greater probative value on the physical therapy ROM study which was more proximate to separation and taken together the two examinations support the Board’s contention that the CI’s TL ROM was not frequently or permanently limited to TL flexion of 60 degrees or combined ROM of 120 degrees or less.  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 back condition.  

Contended PEB Conditions:  Psoriasis.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended psoriasis 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 Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the back condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended psoriasis, the Board unanimously agrees that it cannot recommend it for additional disability rating.  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 20150615, w/atchs
Exhibit B.  Service Treatment Record

AR20170006585, XXXXXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	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,					      
						      					
Enclosure