RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02193
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030101

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

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 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 - 20020219	VARD - 20030204	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain…	5299-5295	0%	Low Back Pain	5295	10%	20021114	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Low Back Pain (LBP).  In accordance with DoDI 6040.44, the panel is required to recommend a rating IAW the VASRD in effect at the time of separation.  The panel noted that the 2003 Veteran Administration Schedule for Rating Disabilities (VASRD) standards for the spine, which were in effect at the time of separation, were changed to the current §4.71a rating standards in 2004.  The panel must correlate the above clinical data with the 2003 rating schedule; applicable diagnostic codes include: 5292 (limitation of lumbar spine motion); 5293 (intervertebral disc syndrome; based on incapacitating episodes); and 5295 (Lumbosacral strain).  

According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s LBP condition began in March 2000 after falling on two occasions.  She was treated with medications and duty limitations, but had persistent pain.  Shortly after her falls, she found out that she was pregnant which limited further evaluation.  Her pain increased during the pregnancy.  X-rays of the lumbar spine on 22 February 2001, 3 months after delivery, were essentially normal.  A physical examination showed full range of motion (ROM) and a normal neurological examination.  Tenderness was present.  She was again treated with medications and back exercises.  Her pain persisted and X-rays of the sacroiliac joints (SIJs), the joints between the pelvis and sacrum, were accomplished on 2 April 2001.  These were unremarkable other than osteitis condensans ilii, a benign finding seen in about 1-3% of women and thought to be related to pregnancy.  She was tender over the right SIJ and was treated with a steroid injection.  This provided some relief, but her pain persisted.  Her ROM remained normal.  A series of injections was begun again on 29 November 2001, but this aggravated her pain.  X-rays of the lumbar spine were repeated on 11 January 2002 and were again normal.  Her commander noted that she was a good worker and recommended reclassification.  A MOS medical retention board (MMRB) on 22 March 2002 recommended referral to MEB.  

During the 10 April 2002 MEB examination (recorded on DD Forms 93 and 2808) 9 months prior to separation, the CI reported ongoing low back pain.  The examination showed a normal neurological examination, but limited ROM.  Flexion was 30 degrees, extension 6 degrees, “lateral left” (side bending presumably) was 16 degrees and 22 degrees on the right.  The MEB NARSUM examination, dated 19 April 2002, 9 months prior to separation, noted complaints of ongoing LBP.  On the physical examination, the ROM of the back was recorded as full, but the above measurements were also cited.  The neurological examination was normal.  Testing for SIJ dysfunction was positive.  The MEB recommended referral to a PEB for sacroiliitis with lumbar back pain.  An MRI of the pelvis dated 12 August 2002 showed the previously seen osteitis condensans ilii, but was otherwise unremarkable.  Pathology of the SIJs was not documented.  

At the VA Compensation and Pension (C&P) evaluation performed on 14 November 2002, 6 weeks before separation, the CI reported ongoing low back pain.  Incapacitation was not recorded.  On examination, flexion was normal at 90 degrees with extension limited to 15 degrees (30 is normal) and right and left lateral flexion limited to 25 degrees (30 is normal).  Rotation was not recorded.  The reflexes were normal and atrophy absent.  She was thought to have bilateral sacroiliac irritation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP condition 0%, coded 5295 (lumbosacral strain), citing normal ROM and a normal neurological examination.  The VA rated the LPB condition 10%, coded 5295 (lumbosacral strain), based on the C&P examination 2 months before separation, citing painful and limited motion.  The panel considered the evidence.  It supported the presence of slightly limited, painful motion.  This supported a 10% rating under either the code 5292 (lumbar limitation in motion) or 5295.  No route to a higher rating was found.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the LBP condition, coded 5295.  

BOARD FINDINGS:  In the matter of the LBP condition, the panel unanimously recommends a disability rating of 10%, coded 5295 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel 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	
Low Back Pain…	5295	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150731, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170014672, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,	
Enclosure