RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02568
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20061219

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty O3, Personnel System Management, medically separated for “chronic low back pain” with a disability rating of 0%.

CI CONTENTION:  “My physical examination was never fully completed, I was required to complete a mammogram, but was nursing and pregnant.  I would like to complete my physical and rating.”  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 - 20060911	VARD - 20070827	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	0%	Low Back and Sacroiliac Joint Pain	5237	0%	STR	
Migraine Headaches	Not Unfitting	Migraine	8100	0%	STR	
Mycobacterium Fortuitum/Chelonae Complex	Not Unfitting	No VA Placement	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:

Chronic Low Back Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in 2002 after a bad landing during airborne training.  Radiographic (X-ray) studies showed normal sacroiliac joints.

At the 15 May 2006 MEB NARSUM examination, 7 months prior to separation, noted complaints of chronic low back and pelvic pain; aggravated while carrying light weight, night pain and normal everyday activities.  Physical examination showed negative straight leg raise testing for radiculopathy.  Range of motion (ROM) was decrease for the lumbar spine (measurements were not cited) with painful motion secondary to pelvic pain.

At the 19 June 2006 physical medicine clinic examination, 6 months prior to separation, the CI reported chronic bilateral sacroiliac joint pain left greater than right.  There was no radicular pain or paresthesias noted and the CI was in no pain.  Physical examination showed no spinal tenderness, straight leg raise testing was negative, and bilateral lower extremity motor strength was 5/5.  Lumbar ROM was within normal limits (measurements not cited) without painful motion.

At the 17 August 2006 MEB physical therapy clinic examination, 4 months prior to separation, the CI reported chronic back pain and was 3 months pregnant.  ROM was flexion to 50 degrees (normal 90) and combined ROM was145 degrees (normal 240) with painful motion.

There was no VA examination proximate to separation for the panel to review.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 0%, coded 5237 (lumbosacral strain), citing no evidence of:  spasms, abnormal gait, or spinal tenderness.  The VA also rated the back condition 0%, also coded 5237, based on the service treatment records (CI missed VA examination due to pregnancy), citing a non-compensable evaluation.

The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees) supported by the MEB NARSUM and MEB physical therapy examinations.  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).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the low back condition, coded 5237.

Contended PEB Conditions:  Migraine Headaches and Mycobacterium Fortuitum/Chelonae Complex.  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 chronic low back pain condition, the panel unanimously recommends a disability rating of 20%, coded 5237 IAW VASRD §4.71a.  In the matter of the contended migraine headaches and mycobacterium fortuitum/chelonae complex 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 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	
Chronic Low Back Pain	5237	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160705, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170013325, 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