RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY CASE NUMBER: PD1201023 SEPARATION DATE: 20020814 BOARD DATE: 20130124 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (13B/Canon Crewmember), medically separated for chronic low back pain (LBP) secondary to spondylolysis at L-3 without neurologic abnormality. The CI had a long history of LBP which did not improve adequately with treatment and he was unable to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was issued a permanent L3 profile and referred to a Medical MOS Retention Board (MMRB) which recommended he be referred for a Medical Evaluation Board (MEB). The MEB forwarded the condition as chronic LBP secondary to bilateral pars defects (spondylolysis) at the L3 level. One additional not unfitting condition, identified in the rating chart below, was also identified and forwarded by the MEB. The Physical Evaluation Board (PEB) adjudicated the chronic LBP condition as unfitting, rated 10% with application of the Department of Defense Instruction (DoDI) 1332.39 and AR 635-40. The remaining condition was determined to be not unfitting and was not rated. The CI made no appeals, and was medically separated with a 10% disability rating. CI CONTENTION: The CI elaborated no specific contention in his application. SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2) is limited to those conditions which were determined by the PEB to be specifically unfitting for continued military service; or, when requested by the CI, those condition(s) “identified but not determined to be unfitting by the PEB.” The ratings for unfitting conditions will be reviewed in all cases. The rated condition chronic LBP is the only condition that meets the criteria prescribed in DoDI 6040.44 for Board purview; and, is addressed below. Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Army Board for Correction of Military Records. RATING COMPARISON: Service PEB – Dated 20020405 VA (6 Mos. Pre-Separation) – All Effective Date 20020815 Condition Code Rating Condition Code Rating Exam Chronic Low Back Pain 5299-5295 10% Spondylolysis L3 with Degenerative Joint Disease 5293 10% 20020205 Hepatitis B Not Unfitting Hepatitis B 7345 0% 20020205 .No Additional MEB/PEB Entries. 0% X 2 / Not Service-Connected x 1 20020205 Combined: 10% Combined: 10% ANALYSIS SUMMARY: Chronic Low Back Pain Condition. The CI developed LBP approximately 1995 when he injured his back while lifting heavy field artillery rounds. Over the next several years, he was treated non-surgically; however he was not able to be rehabilitated and his pain became more persistent, especially after heavy physical activity. At the MEB evaluation from 12 March 2002 (5 months prior to separation), the CI reported back pain with vigorous physical activity with occasional radicular symptoms into the legs. On examination, he had a normal gait (normal heel and toe gait). His back flexion was mildly reduced with the ability to forward flex bringing the tips of his fingers to the distal one-third of his legs (approximately 70 to 80 degrees). He had 20 degrees of extension and side bending (left and right) to 20 degrees. He was tender to palpation over the lower lumbar spine, especially in the midline. Straight leg raising (SLR) was negative for nerve root irritation and strength, reflexes and sensation were normal. Imaging was noted to show degenerative disc and joint disease of the lumbar spine. At the VA Compensation and Pension (C&P) evaluation on 5 February 2002, 6 months prior to separation, and a month before the MEB narrative summary (NARSUM), he had a normal gait and posture. The lumbar spine had forward flexion 80 degrees, extension 20 degrees, lateral bending 40 degrees bilaterally, rotation 45 degrees bilaterally. LBP elicited with right SLR and with extension and rotation. The Board directs attention to its rating recommendation based on the above evidence. In accordance with DoDI 6040.44, the Board is required to recommend a rating IAW the VASRD in effect at the time of separation. The Board notes that the 2002 Veteran Administration Schedule for Rating Disabilities (VASRD) standards for the spine, which were in effect at the time of separation, were changed to the current §4.71a rating standards in 2004. The Board must correlate the above clinical data with the 2002 rating schedule (applicable diagnostic codes include: 5292 limitation of lumbar spine motion; 5293 intervertebral disc syndrome; and 5295 Lumbosacral strain). The PEB rated the condition 10% coded 5299-5295 for lumbosacral strain citing chronic LBP secondary to spondylolysis at L-3 without neurologic abnormality or documented chronic paravertebral muscle spasms on repeated examinations, with characteristic pain on motion. The VA rated 10% citing diagnosis code 5293 (intervertebral disc syndrome). Board members agreed the range-of-motion (ROM) on both examinations was consistent with the 10% rating under 5292, limitation of motion. Under 5295, the condition would be rated as 10% for characteristic pain on motion. There were not features on examinations to support a higher rating than 10%. The Board then considered whether the CI could get a higher rating under diagnosis code 5293. There is no documentation in the service treatment record (STR) of recurring attacks of such severity to support a 20% rating under this code. With no documented sciatic neuropathy or any abnormal neurologic findings, the CI would be rated as "mild" under this code 5293 (10%). After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the chronic low back pain condition. BOARD FINDINGS: IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication. As discussed above, PEB reliance on DoDI 1332.39 for rating chronic LBP was operant in this case and the condition was adjudicated independently of that instruction by the Board. In the matter of the chronic low back condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. There were no other conditions within the Board’s scope of review for consideration. RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows: UNFITTING CONDITION VASRD CODE RATING Chronic low back pain 5299-5295 10% COMBINED 10% The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20120626, w/atchs Exhibit B. Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record XXXXXXXXXXXXXXXXXXXXXXXX, DAF Acting Director Physical Disability Board of Review SFMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (TAPD-ZB / XXXXXXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA 22202- 3557 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXX, AR20130006094 (PD201201023) I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual. Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation and hereby deny the individual’s application. This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail. BY ORDER OF THE SECRETARY OF THE ARMY: Encl XXXXXXXXXXXXXXXX Deputy Assistant Secretary (Army Review Boards)