RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01661
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060527

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Administrative Specialist, medically separated for “low back pain,” with a disability rating of 10%.

CI CONTENTION:  “Review 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 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 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 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 – 20060131	VARD - 20070405	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5237	10%	Lumbar Spine Strain	5237	10%	20061021	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had a 1 year history of low back pain that first occurred after a training exercise.  At the 7 October 2005 physical therapy (PT) evaluation, the CI had a normal gait, full range of motion (ROM), and normal strength.  There was tenderness at the right sacroiliac (SI) joint.  At the 13 October 2005 orthopedic clinic encounter, an MRI was reported to be normal.  Examination noted tenderness to palpation and full ROM.  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 MEB.  

At the MEB examination (recorded on DD Forms 2807 and 2808) dated October 2005, 7 months prior to separation, the CI reported back pain with occasional numbness and tingling in the right foot.  The MEB NARSUM examination on 15 January 2006, 4 months prior to separation, noted complaints of bilateral low back pain exacerbated by activities to include running and lifting.  The physical examination documented a normal posture and gait.  The back examination revealed diffuse low back and SI joint tenderness.  Lumbar spine range of motion (ROM) was full.  The Patrick test (assesses hip and SI joint pathology) was positive and the straight leg raise (SLR) test (assesses for herniated disc causing radiculopathy) was negative.  There was no evidence of lower extremity neuropathy.  Strength and deep tendon reflexes (DTRs) were normal.  The lumbosacral spine X-rays were normal and the MRI was without evidence of neuroforaminal (nerve root opening) narrowing.  

At the 21 October 2006 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI complained of constant sharp, aching, mid lumbar pain with associated stiffness, weakness, and spasm.  She reported rare right lower extremity weakness, numbness, and paresthesias (abnormal sensation, tingling, burning, and prickling).  The CI denied fecal or urinary incontinence.  The physical examination documented a normal gait.  The thoracic sacrospinalis examination revealed right sided tenderness with no atrophy, muscle spasm, guarding, or abnormal spinal curvature.  There was no muscle spasm, localized tenderness, or guarding severe enough to be responsible for an abnormal gait or abnormal spinal contour.  Pain-limited thoracolumbar spine ROM was flexion of 70 degrees (90 normal) and total combined motion of 220 degrees (240 normal).  There was no additional loss of motion on repetitive use.  The SLR test was negative.  Strength, sensation, and DTRs were normal and pathologic reflexes were absent.  The lumbar spine X-ray was normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5237 (lumbar spine strain), citing no significant loss of spinal motion or radiculopathy.  Tenderness to palpation was present.  The VA also rated the back condition 10% coded 5237, based on the C&P examination 5 months after separation, citing flexion of 70 degrees and a combined ROM of 220 degrees.  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 VA examination which provided actual measurements and was therefore more probative.  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 associated radiculopathy for separate peripheral nerve rating.  While the CI may have experienced radiating pain from the back condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  There was no objective evidence of a radiculopathy with functional impairment (such as weakness) that directly impacted fitness for duty.  The panel therefore concluded that an additional disability rating was not justified on this basis.  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 low back condition.  

BOARD FINDINGS:  In the matter of the low back condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were 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 20150621, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170008588, 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