RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:	CASE:  PD1201059
BRANCH OF SERVICE:  ARMY	BOARD DATE: 20130530
SEPARATION DATE: 20030603

SUMMARY OF CASE:   Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (11B/Infantryman) medically separated for low back pain (LBP).  The CI started to experience back pain shortly after he underwent a spinal tap in 2001 to rule out possible meningitis.  Despite various conservative treatment (including medication, therapy, and steroid injections) the back pain could not be adequately rehabilitated to meet the requirements of his Military Occupational Specialty or physical fitness standards. He was therefore issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).   The back condition, characterized as “lumbar spine: mechanical low back pain,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded one other condition (“intermittent rib popping”) for PEB adjudication.   The PEB adjudicated “mechanical low back pain” as unfitting and rated 10%.  The remaining condition was determined to be not unfitting.  The CI did not concur with the PEB, but did not submit an appeal and did not demand a formal hearing.  The US Army Physical Disability Agency replied to the  CI’s  non-concurrence  via  memorandum  indicating  the  PEB  had  adjudicated  the  case correctly but made an administrative change to the PEB report that made a change to the VA condition code used for the back pain. The CI made no appeals and was medically separated.

CI CONTENTION:  “The condition is getting much worse and is now creating more injuries.  It is also keeping me from getting & or keeping employment which is needed to support my family.”

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 low back condition 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 Board for Correction of Military Records.

The Board acknowledges the CI’s concerns regarding the significant impairment with which his service-connected condition continues to burden him but must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for future severity or potential complications of conditions for which they were medically separated. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.

RATING COMPARISON:

Service PEB – Dated 20030214	VA - (2 Mos. Pre-Separation)
Condition	Code	Rating	Condition	Code	Rating	Exam
Mechanical Low Back Pain…	5299-5295	10%	Mechanical Low Back Pain	5292	20%*	20030407
Intermittent Rib Popping	Not Unfitting	Right Rib Nodule	7819	0%
No Additional MEB/PEB Entries	No Additional VA Entries
Combined: 10%	Combined: 20%
VA Rating Decision (VARD) 20020715 NSC; VARD 20050829 service connected.

ANALYSIS SUMMARY:

Mechanical Low Back Pain.  The narrative summary notes the CI reported the onset of LBP following a lumbar puncture (LP) in December 2001 to rule out meningitis. He developed a post LP headache and was treated with an epidural injection of blood to seal the opening in the spinal canal covering and relieve the headache.  The CI noted that his LBP was increased following this procedure despite the fact that the headache was successfully relieved and there were no complications at the time of the injection.  The CI was provided a temporary 30 day profile and was not seen again until April 2002.  Lumbar X-rays in April 2002 and magnetic resonance imaging (MRI) performed in May 2002 were normal.   The CI’s treatment included physical  therapy  and  epidural  steroid  injections,  but  his  LBP  continued.     At  the  MEB examination performed 2 January 2003, approximately 5 months prior to separation, the CI reported LBP.   The MEB physical exam noted lumbar range-of-motion (ROM) of flexion 0-50 degrees (normal 90 degrees) but otherwise normal ROM.  There was tenderness to palpation of the lumbar spine without muscle spasm.  Straight leg raise (SLR) was negative bilaterally.  On the DD Form 2808 from 16 December 2002 the same MEB examiner noted normal sensory, motor, and reflexes.  The examiner noted that the findings were the same as the 30 December
2002  exam  by  the  orthopedic  consultant.    At  the  VA  Compensation  and  Pension  exam performed 7 April 2003, approximately 2 months prior to separation, the CI reported constant pain in the low back without radiation or other neurological abnormalities.  The VA exam noted a normal gait.  Lumbar ROM was flexion 0-50 degrees, otherwise ROM was normal.  There was no TTP noted.  SLR was negative bilaterally with increased lumbar pain without radiation to the legs.  Reflexes were normal bilaterally.  There were no DeLuca criteria present on evaluation. The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Thoracolumbar ROM (Degrees)	
Ortho/MEB exam
(20021230)	MEB ~5 Mo. Pre-Sep
(20030102)	VA C&P ~2 Mo. Pre-Sep
(20030407)	
Flexion (90 Normal)	45	50	50	
Extension (30)	“full”	35	35	
R Lat Flexion (30)	30	35	35	
L Lat Flexion (30)	30	35	35	
R Rotation (30)	-	35	35	
L Rotation (30)	-	35	35	
Combined (240)				

Comment	“Hands 24 in. fr flr”;nl sens;reflexes; able to heel/toe walk;SLR neg	Neg SLR; no spasm.	Flex/ext with pain EROM; Nl gait and reflexes.	
§4.71a Rating	20%	20%	20	

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated the LBP condition as 5299-5295 (lumbosacral strain) at  10%, citing pain limited motion  without muscle spasm or radiculopathy.   The VA rated the LBP condition as 5292 (limited lumbar motion) at 20% for moderate limitation of the lumbar spine.   The Board is

required to provide a disability rating in accordance with VASRD rating guidelines in effect on the date of separation and the Board did so.  The Board deliberated the rating of the LBP condition.  The CI was noted on all exams in the ROM chart above to have lumbar ROM limited to 45 degrees to 50 degrees, with painful motion, but without muscle spasm, radiculopathy, or incapacitating episodes.   The Board agreed that rating according to VARSD spine rating guidelines in effect June 2003, the CI’s LBP condition met the 10% rating coding as 5295 for characteristic pain on motion, without muscle spasm, but met the 20% rating coding as 5292 for moderate limitation of lumbar motion.   After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Reasonable doubt), the Board recommends a disability rating of 20% for the LBP 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.   The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the LBP condition, the Board unanimously recommends a disability rating of 20%, coded 5292 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.

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

UNFITTING CONDITION	VASRD CODE	RATING	
Low Back Pain Condition	5292	20%	
	COMBINED	20%	

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120603, w/atchs
Exhibit B. Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

Physical Disability Board of Review

SFMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(TAPD-ZB), 

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for AR20130014992 (PD201201059)

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						
						         (Army Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA