RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02357
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041110

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 low back pain,” rated 10%.  

CI CONTENTION:   The CI contends her condition was more severe than the disability rating she received, and that the condition has worsened.  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 – 20040902	VARD - 20050518	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain…	5237	10%	Chronic Strain Low Back	5237	10%	20050203	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in February 2002 during basic training after ruck marching and heavy lifting.  The 7 April 2004 lumbar spine X-rays showed sacralization (congenital anomaly of lowermost lumbar segment [L5] fused to sacrum) of L5 with pseudoarticulation (false joint or nonunion) of the left transverse process with the sacrum.  A 19 May 2004 pelvis and hip nuclear medicine bone scan was unremarkable.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  

At the 5 August 2004 orthopedic surgery MEB consultation, 3 months before separation, the CI reported non-radiating 5-6/10 back pain which prevented running, walking more than 1 – 1 ½ miles, or lifting greater than 30 pounds.  She denied numbness, tingling, and bowel or bladder symptoms.  The physical examination documented the CI was “able to walk on both heels and toes without difficulty.”  The lumbar spine range of motion (ROM) was flexion of 80 degrees (normal 90), extension of 30 degrees (normal 30), and bilateral lateral bending of 30 degrees (normal 30).  The straight leg raise ([SLR] assesses for herniated disc causing sciatic nerve root [L5-S1] radiculopathy) tests and Waddell’s (psychogenic, or nonorganic, manifestations of pain) signs were negative.  Strength, sensation, and deep tendon reflexes (DTRs) were normal.  The diagnosis listed mechanical low back pain.  On 23 August physical therapy (PT) measured ROM for the MEB with a goniometer (except rotation).  Pain-limited lumbar spine ROM was flexion of 53 degrees, extension of 24 degrees, and right lateral flexion of 25 degrees, left lateral flexion of 30 degrees, and bilateral rotation of 30 degrees.  The 24 August 2004 MEB NARSUM examination, 3 months prior to separation, noted complaints of constant low back pain aggravated by sitting or standing for more than 10 minutes, repeated bending, heavy lifting, running, or any impact activities.  The CI was taking a narcotic pain reliever (Ultram [tramadol]).  The lumbar spine examination revealed no tenderness, palpable spasm, or visible deformity.  The examiner cited the PT for MEB lumbar spine ROM Optional Form 275.  Pain-limited lumbar spine ROM was flexion of 53 degrees, extension of 22 degrees, right lateral flexion of 25 degrees, left lateral flexion of 23 degrees, and bilateral rotation of 30 degrees.  The SLR tests were negative and 1/5 Waddell's signs (rotation) was positive.  The DTRs and sensation were normal “except for slightly decreased sensation in the right hand in a stocking/glove distribution.”  The diagnosis listed lumbar spine mechanical low back pain.  

At the 3 February 2005 VA compensation and pension (C&P) evaluation, 3 months after separation, the CI reported constant low back pain “sometimes going to her knees,” rated 8/10 in severity, and treated with narcotic (tramadol, Percocet, and Tylenol 3) medications.  The CI indicated this back pain limited standing, sitting, and driving.  Physical examination showed a normal gait and posture.  The thoracolumbar spine examination revealed no tenderness, muscle spasm, ankylosis (joint stiffening or immobility), radiation of pain on movement, or evidence of intervertebral disc syndrome.  Thoracolumbar spine ROM values showed flexion of 85 degrees, extension of 15 degrees, bilateral lateral flexion of 30 degrees, right rotation of 30 degrees, left rotation of 20 degrees (normal 30), and combined of 210 degrees (normal 240).  With repetitive ROM, there is no additional limitation based on pain, fatigue, weakness, lack of endurance, or incoordination.  The SLR tests were negative.  Strength, sensation, and DTRs were normal.  The lumbar spine X-rays revealed a transitional lumbosacral segment with partial sacralization of L5.  The diagnosis listed chronic low back strain.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 5237 code (lumbosacral strain) citing chronic low back pain, X-ray findings of sacralization of L5 with pseudoarthrosis of the left transverse process (EPTS), and ROM.  The VA assigned a 10% rating under the 5237 code (lumbosacral strain) based on the VA C&P examination 3 months after separation, citing chronic low back strain, chronic back pain,  X-ray findings of sacralization of L5 with pseudoarthrosis of the left transverse process, and ROM.  The orthopedic MEB consult and VA C&P examination ROM values were consistent with the 10% rating (flexion of greater than 60 degrees but not greater than 85 degrees; or a combined ROM of greater than 120 degrees but not greater than 235 degrees of the thoracolumbar spine).  The higher 20% rating would require (flexion of greater than 30 degrees but not greater than 60 degrees; or a combined ROM of not greater than 120 degrees of the thoracolumbar spine).  The PT for MEB and MEB NARSUM examination ROM values were consistent with the 20% rating.  The panel assigned more probative value to the VA C&P examination because it measured repetitive thoracolumbar spine ROM.  The panel assigned less probative value to the orthopedic MEB consult, PT for MEB, and MEB NARSUM examinations because they measured lumbar spine ROM.  There was no evidence of intervertebral disc syndrome (IVDS) which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula (for IVDS).  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.  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 chronic low back pain.  

BOARD FINDINGS:  In the matter of the chronic low back pain and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150915, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170012614, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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