RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01452
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20040411

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Unit Supply Specialist, medically separated for “chronic low back pain” with a disability rating of 20%.

CI CONTENTION:  “Review all conditions.”  The CI’s 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 at the time of separation.  The panel has neither the role nor the authority to compensate for progression or complications of service-connected conditions after separation.  That role and authority is granted by Congress to the Department of Veterans Affairs (VA), 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 - 20040217	VARD - 20040526	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	20%	Degenerative Joint Disease Lumbar Spine	5237	20%	20040408	
Asthma	Not Unfitting 	Asthma	6602	30%		
Allergies		Sinusitis	6510	10%		
Migraine Headaches		No VA Placement	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50% 	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began on 27 July 2001 after a parachute accident where she fell from a 34-foot tower and landed on her back during airborne training.  X-ray studies in June 2003 showed degenerative disc disease at L5-S1.  An MRI in July 2003 showed minimal degenerative changes at L4-5-S1 without significant central canal or neuroforaminal stenosis.  Electrodiagnostic studies in July 2003 showed no evidence of lumbar radiculopathy; however, there was evidence of a moderate demyelinating peroneal motor neuropathy bilaterally (unrelated to the back).  Despite treatment, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty.  At the 5 June 2002 physical therapy clinic appointment for an initial examination, the CI reported low back pain.  Physical examination found no limitations of motion.  

At the 16 September 2003 physical medicine clinic appointment, 7 months prior to separation, the CI reported daily chronic low back pain.  The pain was worse with sitting, long runs, or heavy lifting.  Physical examination of the lumbosacral spine (not thoracolumbar spine) showed normal range of motion (ROM) with flexion of 60 degrees (normal 90) and a combined ROM of 175 degrees (normal 240).  There was no tenderness to palpation.  The 5 February 2004 MEB NARSUM examination, 2 months prior to separation, noted complaints of low back pain.  Physical examination showed tenderness to palpation over her lumbosacral paraspinal muscles bilaterally.  She had decreased ROM in both flexion and extension without recorded measurements.  

At the 8 April 2004 VA Compensation and Pension (C&P) evaluation, performed 3 days before separation, the CI reported dull aching low back pain, particularly with forward bending.  She reported she did not have acute flares and no radiation of the pain to the legs.  Physical examination showed the CI did not walk with a limp, there was no tenderness and ROM measurements showed a flexion of 60 degrees and a combined ROM of 185 degrees.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 20%, coded 5237 (lumbosacral strain), citing limitation of motion with no focal neurological deficits.  The VA also rated the back condition 20% coded 5237, citing limitation of forward flexion.  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) reported on the VA C&P examination.  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 there was insufficient cause to recommend a change in the PEB adjudication for the chronic low back pain condition.  

Contended PEB Conditions:  Asthma, Migraine Headaches and Allergies.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  The asthma condition (dyspnea on exertion) which was initially profiled and caused the CI to be reassigned from Korea back to CONUS, after an extensive work-up including pulmonary function testing, exercise pulmonary function testing, methacholine testing, laryngoscopy looking for vocal cord dysfunction and echocardiogram failed to show a cause of the complaint of shortness of breath.  The medication profile submitted with the MEB showed the CI had not had any asthma medications in the 6 months prior to submission and the permanent profile did not list asthma or any other breathing difficulties.  The migraine condition was initially causing the CI to stop what she was doing and rest but had been treated and with prophylactic medications and by April 2003 was “doing significantly better” and no longer interfering with the performance of duty.  The allergy condition, like shortness of breath, was profiled due to the CI’s complaint of allergy symptoms when cutting grass or performing physical training on grass at one point but on two separate occasions the CI’s allergy skin tests were negative for allergy to any type of grass tested for.  None of these conditions were permanently 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 and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended migraine headaches, allergies, and asthma 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.  Therefore, the panel recommends 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 20161004, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20180001603, 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