RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00333
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070618

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Supply Clerk, medically separated for “low back pain” and “plantar fasciitis due to developmental pes planus” with a combined 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 - 20070517	VARD - 20080208	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5299-5237	10%	Degenerative Changes Disc Bulging L3-L4	5237	0%	20071004	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Back Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began after it was identified by family practice for further evaluation before starting a MEB for her bilateral foot condition.  The CI had no history of treatment for back pain prior to this.  The 31 January 2007 podiatry evaluation for bilateral foot pain noted complaints of left side low back pain (LBP) on exertion or under load because she favored her right foot.  The NARSUM also noted that the CI reported back pain since epidural anesthesia during the birth of her second child. 

The 23 April 2007 physical therapy evaluation measured range of motion (ROM) for the MEB.  Flexion was 80 degrees (normal 90) and a combined ROM of 230 degrees (normal 240), with painful motion noted.  

The 1 May 2007 MEB NARSUM examination, 1 month prior to separation, noted complaints of intermittent pain that occurred when moving the wrong way or randomly.  Physical examination showed negative straight leg raise testing to elicit nerve tension signs.  There was tenderness to palpation of the spine and paraspinal muscles that the examiner noted were out of proportion to the examination.    

Magnetic Resonance Imaging (MRI) on 9 May 2007 showed localized degenerative disc disease at L3-L4 level.  The CI’s low back pain was thought to be secondary to the epidural as well as secondary to altered biomechanics caused by the chronic foot condition.  

At the 4 October 2007 VA Compensation and Pension (C&P) evaluation, 4 months after separation, the CI was 26 weeks pregnant.  She reported stiffness of the lumbar spine with pain occurring three times per day, lasting 1 hour each time.  Pain was reported as sharp, traveling down the spine.  Pain was elicited by physical movement/activity and relieved with rest and Percocet (narcotic pain medication).  The CI reported incapacitating episodes as often as four per month, lasting 2 days.  She reported 20 incidents of incapacitation for a total duration of 80 days in the past year.  She provided the phone number of a physician she said recommended bed rest 2 months earlier.  Physical examination showed a normal gait and posture with normal spinal curvatures.  There was no TTP, muscle spasm or radiating pain with movement.  Thoracolumbar ROM was 90 degrees flexion and 240 degrees combined.  There was no additional loss of ROM with repetitive motion.  There were no signs of intervertebral disc syndrome with chronic or permanent nerve root involvement.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5299-5237 (analogous to lumbosacral strain), citing localized tenderness with range of motion greater than 240 degrees.  The VA rated the back condition 0% coded 5237 (lumbosacral strain), based on the VA C&P examination 4 months after separation, citing no limitation of motion to the lumbar spine and no tenderness noted.

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) and combined ROM (greater than 120 degrees but not greater than 235 degrees) as reported on the MEB PT examination.  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).  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 back condition. 

BOARD FINDINGS:  In the matter of the back condition 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 20160518, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

	

AR20170015284, 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.

Sincerely,					      
						      					
Enclosure