RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01574
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040130

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an E4, Motor Transport Operator, medically separated for “low back pain” and “chronic pelvic pain,” rated 10% each, with a combined disability rating of 20%.  

CI CONTENTION:  “I have been dealing with PTSD/MST since I have gotten out of the military.  My condition has become worse.”  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20031016	VARD - 20040420	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237-8720	10%	Residuals of Microscopic Discectomy of the Lumbar Spine…	5243	10%	20040408	
Chronic Pelvic Pain	7699-7629	10%	Endometriosis  with Laparoscopy	7629	NSC	20050111	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record (STR) and the MEB narrative summary (NARSUM), the CI’s back condition began in 1996 when she developed an onset of low back and right hip, buttock, and leg pain following jumping off a truck.  On 23 February 2000, she underwent a right sacroiliac joint fusion.  She did well postoperatively until April 2000, when she began to note the onset of radiating right posterior thigh pain when sitting.  On 12 September 2001, the CI underwent a right L5-S1 microlumbar discectomy, and she had another surgery in December 2002 at L4-5.  On 25 March 2003, an MRI revealed no evidence of a recurrent disk herniation at L4-5 or L5-S1.  There was evidence suggestive of epidural fibrosis; however, the foramina was patent bilaterally.

The 30 July 2003 MEB NARSUM examination, 6 months prior to separation, noted complaints of intermittent right lower extremity radicular symptoms.  Physical examination showed a well healed scar at L4-5 and L5-S1.  Motor strength was normal in the lower extremities, and no focal sensory deficits were found.  Reflexes were intact.

At the 8 April 2004 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported constant low back pain with numbness down the right lower extremity.  Physical examination showed no muscle spasm or tenderness.  Range of motion showed thoracolumbar flexion 80 degrees (normal 90), extension 20 degrees (normal 30), and lateral flexion and rotation movements were 30 degrees, bilaterally (normal).  Pain was present with all movements.  Sensory and neurological examinations were normal for the lower extremities.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5237-8720 (lumbosacral strain-neuralgia), citing intermittent right lower extremity radicular symptoms, straight leg raise was positive on the right and exacerbated with foot dorsiflexion.  No focal deficits were reported. The VA rated the back condition 10%, coded 5243, (intervertebral disc syndrome), based on the C&P examination, citing forward flexion of the thoracolumbar spine of 80 degrees.

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) as reported on the VA examination proximate to separation.  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.  The 8720 code is limited to 10%; however, the panel also considered the superficial peroneal nerve code (8522) based on the finding of possible mild superficial neuropathy during EMG study in January 2004, but this code would not result in a higher rating since the condition did not rise to the level of severe impairment.  There were no additional applicable codes to consider.  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 back condition.  

Chronic Pelvic Pain.  According to the STR, the MEB NARSUM, and 15 September 2003 MEB addendum, the CI had a longstanding history of chronic pelvic pain.  In October 2000 the CI underwent a laparoscopy with finding of lesions which were compatible with endometriosis; however the biopsy returned showing no endometriosis seen.  Despite multiple medications, to include birth control pills, the CI’s pain continued.

The 15 September 2003 addendum to MEB examination, 4 months prior to separation, noted complaints of chronic pelvic pain that was severe enough to interfere with everyday activities.  Irregular and or heavy menses were not reported.  Physical examination showed tenderness in the lower abdomen, and no evidence of enlarged organs or masses.  Gynecological examination was unremarkable with the exception of tenderness in the cervix during manipulation, and fibrous breast tissues.  The examiner assessed chronic pelvic pain; probable endometriosis with negative biopsy.

The 8 April 2004 C&P examination did not address this condition, therefore, the VARD noted the issue of compensation was deferred for a VA examination.  On 11 January 2005, 12 months after separation, the CI was evaluated for the claimed condition of endometriosis with laparoscopy.  At the time she reported she had a normal menstrual period in December 2004, and that she was having regular periods that lasted for 2-3 days; the first day with some spotting, the second day heavy bleeding, and the third day her period was over.  Throughout the period she developed cramping and abdominal pain.  She was not on any medicines and she reportedly stated the condition had caused no functional impairment.  Physical examination was unremarkable.  The examiner diagnosed functional dysmenorrhea.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the chronic pelvic pain condition 10%, coded analogously 7699-7629 (endometriosis), citing suspected endometriosis, but negative biopsy.  The VA initially deferred this condition but later determined that the condition of endometriosis was not service connected, citing, “the medical evidence of record fails to show that this disability has been clinically diagnosed.”  

The 10% rating is justified when pelvic pain or heavy or irregular bleeding requires continuous treatment for control, and the higher rating of 30% under the 7629 code is warranted when pelvic pain or heavy or irregular bleeding is not controlled by treatment.  The panel noted the MEB addendum diagnosed chronic pelvic pain and recommended that the CI “meet a medical board due to her severe back pain and inability to perform normal soldier duties.”  Such a recommendation implies that the pelvic pain was not of such severity as to end the CI’s military career.  STR documentation was scarce and without evidence of medical visits for this condition for 2003 and 2004.  The January 2005 gynecologic evaluation noted the CI was taking Motrin as needed, had regular menses that lasted only 3 days, and the condition had not caused any functional impairment.  Panel members concluded the condition was most reflective of the 10% level of disability for requiring continuous treatment for control of symptoms.  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 pelvic pain condition.  

BOARD FINDINGS:  In the matter of the chronic low back pain condition and IAW VASRD §4.71, the panel recommends no change in the PEB adjudication.  In the matter of the chronic pelvic pain condition and IAW VASRD §4.116, the panel recommends no change in the PEB adjudication.  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 20161021, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180007151, 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