RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX		CASE: PD-2015-02465 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20080527

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 “lumbar back pain associated with sacroiliac joint dysfunction” with a disability rating of 10%.

CI CONTENTION: The CI made no specific contention. 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 - 20070522		VARD - 20070920	
Condition	Code	Rating		Condition	Code	Rating	Exam	
Lumbar Back Pain Associated with Sacroiliac Joint Dysfunction	5299-5237	10%		Chronic Lumbosacral Strain	5237	10%	20080618	
Pes Planus	Not Unfitting		Bilateral Pes Planus	NSC	
Iron Deficiency Anemia	Not Unfitting		No VA entry	
COMBINED RATING: 10%		COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Lumbar Back Pain Associated with Sacroiliac Joint Dysfunction. According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in Basic Training after a long ruck march. She completed training and AIT [Advanced Individual Training] and was placed on profile and took anti-inflammatory medication to manage her pain until a MEB was initiated in April 2007. Radiographic studies in August 2007 showed no significant abnormalities. There was minimal scoliosis.  Vertebral bodies were intact and disc spaces were preserved.

At the 11 September 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 8 months prior to separation, the CI reported constant pain and popping in lower back. The CI contends she lost her balance and could not carry her son due to her back locking up and giving out. The CI also complained of numbness in her left leg and foot. Physical examination showed paraspinal tenderness to palpation (TTP) of L4-S1 and SI (sacroiliac) joint TTP. Range of motion (ROM) was limited by pain with decreased motion in all planes. Flexion was 85 degrees (normal 90). The CI had a normal gait, with SLR (straight leg raises), motor strength was 5/5, DTR 2+ and sensation was intact to touch.

The 28 September 2007 MEB NARSUM examination, 8 months  prior to separation, noted complaints of pain even with a profile. She contended it was hard to run, walk or perform her duties. Low back pain was 3-4/10. Walking increased the pain to 5-6/10 and running or jumping increased the pain to 10/10. She took the medications Lodine (anti-inflammatory) and Roaxin (muscle relaxer) for pain. She could not run for more than 50 feet or wear her IBA or Kevlar due to back pain. Additionally she could not perform her duties or walk due to pain. Physical examination and objective findings at the MEB examination are recorded above. At a 5 October 2007 chiropractic visit the CI had full ROM with pain during flexion of the thoracolumbar spine. The examiner recorded TTP, and normal appearance of the spine. During examination of the lumbosacral spine the CI had TTP and exhibited muscle spasms. There was no deformity and posture was normal. Neurological examination revealed a normal gait and no peripheral neuropathy. Sensory examination, deep tendon reflexes (DTR) and motor function tests were within normal limits. Examination did reveal segmental dysfunction syndrome.

At the 18 June 2008 VA Compensation and Pension (C&P) evaluation, performed 1 month after separation, the CI reported complaints of back pain. Physical examination showed tenderness of bilateral paravertebral muscles. No spasm or guarding was noted and the CI had a normal gait and curvature of the spine. SLR was negative. Recorded ROM for flexion was 85 degrees and combined ROM of 235 degrees (normal 240).  There was increased pain at end point but no further limitations after 3 repeated efforts.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the lumbar back pain condition 10%, coded analogously 5299-5237 (lumbar spine strain), citing limitation of motion, with no evidence of additional functional loss due to weakness, fatigability, loss of endurance, and incoordination. The VA also rated the back condition 10% coded 5237(lumbar spine strain), based on the C&P examination 1 month after separation, citing limitation of forward flexion. 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) reported on the MEB NARSUM and VA examinations. 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 documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes which would provide for a higher rating under that formula (for IVDS. It was noted that muscle spasm was present on the chiropractor examination, 6 months prior to separation, however there was not an associated abnormal gait to support the next higher rating of 20% for muscle spasm or guarding severe enough to result in an abnormal gait. 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 pain condition.

Contended PEB Conditions: Pes Planus, and Iron Deficiency Anemia. The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting. None of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards. There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.   After due deliberation, the panel concluded that there was insufficient cause to

recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.

BOARD FINDINGS: In the matter of the lumbar back pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication. In the matter of the contended pes planus, and iron deficiency anemia conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting. 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 20150926, w/atchs Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record

AR20170013238, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	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.

A copy of this decision has been provided to the counsel you listed on your application, XXXXXXXXXXXXXXXXXX