RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01773
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070522

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Military Police, medically separated for “chronic low back pain,” with a disability rating of 0%.  

CI CONTENTION:  Contends her service related injury.  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 - 20070216	VA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	0%	No VA examination in evidence	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back condition began in May 2005 during a ruck march.  Radiographic imaging (X-ray) revealed a normal lumbosacral spine.  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 “mechanical low back” for PEB adjudication.  

A physical therapy (PT) examination on 31 May 2006, 12 months before separation, noted complaints of mid-back pain after falling over bike handle bars (26 April 2006) with pain radiating to chest; exacerbated with sitting, sit ups, stooping, bending and sleeping on back.  Physical examination revealed abnormal kyphosis (back contour) and range of motion (ROM) with painful motion.  During a PT examination on 14 November 2006, 6 months before separation, the therapist noted complaints of low back pain which did not radiate.  Physical examination revealed a normal gait, stance and posture.  The lumbosacral spine ROM did not demonstrated full active ROM, about 25% of normal in all pains, but did note “full lumbar spine flexion bending over to don/doff shoes.”  

The MEB NARSUM examination on 31 January 2007, 4 months prior to separation, noted complaints of low back pain exacerbated by prolonged sitting or standing, running, bending in certain positions, and wearing her protective gear.  Physical examination showed a normal gait and stance.  The thoracolumbar spine ROM, with three repetitions, was flexion at 20 degrees (normal 90), combined ROM of 90 (normal 240) with painful motion in all plains.  

There was no VA Compensation and Pension examination for this Board to review.  The CI did not file a VA disability claim.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 0%, coded 5237 (lumbosacral strain).  The Board agreed that the second PT examination supported a 10%, 20%, or 40% rating while the MEB NARSUM examination supported a 40% rating; both based on limitation in motion.  The Board considered the probative value of these two examinations.  Both examinations were performed by the same physician.  The MEB NARSUM examination was most proximate to separation, more comprehensive with three repetitions of motion, and did not cite any patient malingering or over-exaggeration.  The Board also noted the CI experienced trauma, one year earlier (26 April 2006), when she fell over bike handle bars injuring her cervical spine and chest which could have reasonably contributed to the CI’s severe limitation of motion.  The Board considered the totality of the evidence and concluded that the CI’s back condition supports a 40% rating at separation.  There was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula or evidence of ratable peripheral nerve impairment which would provide for additional rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 40% for the low back condition, coded 5237.  

BOARD FINDINGS:  In the matter of the chronic low back pain condition, the Board unanimously recommends a disability rating of 40%, coded 5237 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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Low Back Pain	5237	40%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150701, w/attachments
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, AR20170000695 (PD201501773)

1.  Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) pertaining to the individual named in the subject line above to re-characterize the individual’s separation as a permanent disability retirement with the combined disability rating of 40% effective the date of the individual’s original medical separation for disability with severance pay.  

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:

	a.  Providing a correction to the individual’s separation document showing that the individual was separated by reason of permanent disability retirement effective the date of the original medical separation for disability with severance pay.

	b.  Providing orders showing that the individual was retired with permanent disability effective the date of the original medical separation for disability with severance pay.

	c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will account for recoupment of severance pay, and payment of permanent retired pay at 40% effective the date of the original medical separation for disability with severance pay.

	d.  Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and medical TRICARE retiree options.

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