RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01566
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060125

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Medical Specialist, medically separated for “chronic low back pain” with a disability rating of 0%.  

CI CONTENTION:  The CI contended that her back pain continues to worsen.  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 - 20051215	VARD - 20061124	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5242	0%	L5-S1 Herniated Disc	5243	NSC	N/A	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

Chronic Low Back Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic low back condition began in September 2001 after sustaining an injury when she jumped out of a truck.  She reported that her pain in her lower back radiated down both legs to her knees.  She continued to have intermittent back pain for 2 years while maintaining temporary profiles.  She re-injured her back on 11 November 2004 when she fell down several stairs.  Initial x-rays of the thoracic and lumbar spine were negative.  A magnetic resonance imaging (MRI) study of the lumbar spine done on 2 February 2005 revealed a disc protrusion at L5-S1 with degenerative disc disease (DDD).  MRI of the thoracic spine done on 4 April 2005 showed a “normal” spine.  Electro-diagnostic studies done on 13 June 2005 were negative for radiculopathy.  There was no surgical indication, and conservative evaluation and treatment by physical therapy, primary care and orthopedics did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “herniated disc, L5/S1” and “degenerative joint disease” for PEB adjudication.  

The MEB NARSUM examination on 9 November 2005, 2 months prior to separation, showed no tenderness, no atrophy and no spasms.  Her range of motion was limited in extension (15 degrees – normal is 30 degrees) and combined range of motion (ROM) was 215 degrees.  Straight leg raise was negative bilaterally.  She had a normal gait and normal toe/heel walking.  Neurologically she had 5% motor strength bilaterally.  Deep tendon reflexes (DTR’s) were +2 bilateral knee jerk, +1 bilateral ankle jerk.  There was slight decrease in sensation in her bilateral heels, but normal in all other areas.  The examiner noted the nerve conduction study (NCS) done on 13 June 2005 as normal.  According to the AMA guidelines pain was moderate and constant.  The CI was taking narcotic pain medications on alternative days plus an over the counter pain medication 3 times per day.  She could not perform in her MOS in-garrison or in the field, was unable to run, do repetitive jumping, march over rough terrain, pull guard duty and work in a cold environment.  There was no VA Compensation and Pension (C&P) evaluation in the record.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic low back condition 0% coded analogously 5299-5242 (degenerative arthritis of the spine), citing VASRD criteria for rating the spine.  The VA determined that the chronic low back condition was not service connected (NSC) based on the unavailability of the CI’s service treatment record (STR).  The Board agreed that a 10% rating, but no higher, was justified for combined ROM (greater than 120 degrees but not greater than 235 degrees) reported on the MEB examinations.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the low back pain condition, coded 5299-5242.  

BOARD FINDINGS  In the matter of the low back pain condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5242 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Low Back Pain	5299-5242	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150622, w/atchs
Exhibit B.  Service Treatment Record

AMR-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, AR20170003523 (PD201501566)

1.  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 to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:
						         
Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA