RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	 CASE:  PD1200618
BRANCH OF SERVICE:  Army 	 BOARD DATE:  20140130
SEPARATION DATE:  20040127		 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (71L, Administrative Specialist) medically separated for a chronic low back condition.  The CI reported a several year history of low back pain (LBP) that started during a military track meet she participated in while stationed Hohenfels, Germany.  She underwent conservative therapy and treatment but the condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The low back condition, characterized as “spondylolisthesis (grade I),” “bilateral lower extremity radiculopathy (S1) and “degenerative disc disease L5-S1,” was forwarded to the Physical Evaluation Board (PEB) In accordance with (IAW) AR 40-501.  The MEB forwarded no other conditions to the PEB. The PEB adjudicated “chronic low back pain with injury” as unfitting rated at 0%.  The PEB stated the condition existed prior to service but further stated that it was aggravated while on active service.  The CI made no appeals, and was medically separated.

CI CONTENTION:  The CI elaborated no specific contention in her application.

SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting chronic low back condition (to include radiculopathy) is addressed below.  No other conditions are within the DoDI 6040.44 defined purview of the Board.  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 Board for Correction of Military Records.

RATING COMPARISON:  

Service PEB – Dated 20031029	VA – (1-Year Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5237	0%	Spondylolisthesis	5239	*20%	20050107	
Combined:  0%	Combined:  20%	
Derived from Decision Review Officer (DRO) decision dated 20050201 (most proximate to date of separation)
*DRO decision dated 20050201 states original rating was 10%, but increases rating to 20% effective at DOS.

ANALYSIS SUMMARY:

Low Back Pain (LBP).  The CI has had a long history of LBP.  She was treated with physical therapy (PT) and medication, but her LBP persisted and an MEB was initiated.  The MEB narrative summary was dictated in September 2003.  At that time, she was healthy-appearing and in no acute distress.  She had good overall balance and was able to heel and toe walk without difficulty.  Tandem gait was normal and straight leg raise was negative.  Neurological exam showed normal reflexes and motor strength, but some loss of sensation on the posterior aspect of the legs.  Range-of-motion (ROM) testing of the lower back revealed approximately 50 degrees of forward flexion.  On 16 October 2003, thoracolumbar ROM was measured by a physical therapist, and the results are summarized in the chart below. 

Thoracolumbar ROM
(Degrees)	MEB/PT ~3½ mos. Pre-Sep
(20031016)	
Flexion (90 Normal)	50	
Extension (30)	30	
R Lat Flexion (30)	30	
L Lat Flexion (30)	20	
R Rotation (30)	45	
L Rotation (30)	40	
Combined (240)	190	
§4.71a Rating	20%	

As noted above, the CI was medically separated from military service in January 2004.  A year later, on 7 January 2005, she had a Veterans Administration (VA) Compensation and Pension exam.  At that exam, she had pain-free lumbar ROM for 40 out of 95 degrees of forward flexion.  After 40 degrees, she had severe pain.  The CI was in moderate distress, and the spine was tender.  There was mild paravertebral muscle spasm.  Strength and sensation were intact in the lower extremities, except for light touch which was decreased along the dorsum of the right-foot.

The Board carefully reviewed all evidentiary information available, and directs attention to its rating recommendation based on the above evidence.  The Army PEB and the VA chose different coding and rating options for the LBP condition.  The PEB used diagnostic code 5299-5237 (analogous to lumbosacral strain) and rated it 0%.  The VA chose code 5239 (spondylolisthesis) and assigned a rating of 10%.  This was later increased to 20% by a Decision 
Review Officer decision dated 1 February 2005.  The Board determined that the October 2003 ROM measurements were performed just 15 weeks prior to separation, and therefore had significant probative value.  At that exam, there was 50 degrees of thoracolumbar forward flexion.  Combined thoracolumbar ROM was 190 degrees.

IAW the VA Schedule for Rating Disabilities (VASRD) §4.71a, a 20% rating is warranted when forward flexion of the thoracolumbar spine is greater than 30 degrees but not greater than 60 degrees.  Based primarily on the evidence from the October 2003 ROM exam, and IAW VASRD §4.71a, the Board determined that a disability rating of 20% was appropriate.  The Board tried to find a path to a higher rating, using other codes which could be applied to the LBP condition.  The other VASRD codes that were considered did not result in a higher rating, since the treatment record did not show sufficient evidence of a disabling spine condition which would justify a rating higher than 20%.  The Board also considered the CI’s radicular symptoms.  After reviewing all the information in the record, there was insufficient evidence of a clinically significant neuropathy that interfered with satisfactory performance of military duties.  There was no unfitting neuropathy present at the time of separation.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board unanimously recommends a disability rating of 20% for the LBP condition.  It is appropriately coded 5239 and IAW VASRD §4.71a and meets criteria for the 20% rating level based on forward flexion greater than 30 degrees but not greater than 60 degrees.

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.
 
In the matter of the LBP condition and IAW VASRD §4.71a, the Board unanimously recommends a disability rating of 20%, coded 5239.

There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that the CI’s prior determination be modified as follows, effective as of the date of her prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Chronic Low Back Pain	5239	20%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20120606, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

XXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review

SFMR-RB			

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXXXXXX, AR20140007577 (PD201200618)

1.  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 to modify the individual’s disability rating to 20% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						     XXXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary
						         (Army Review Boards)