RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-01252
BRANCH OF SERVICE:  Army	BOARD DATE:  20150108
SEPARATION DATE:  20040809

SUMMARY OF CASE:  The available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (42L/Administrative Specialist) medically separated for low back pain (LBP).  The condition could not be adequately rehabilitated to meet the requirements of her Military Occupational Specialty; however her profile indicated she could take an alternate physical therapy test.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The LBP condition, characterized as “chronic nonradicular low back pain,” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The Informal PEB adjudicated the LBP as unfitting, rated 10%, with likely application of the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “The Army did not fully consider my complete medical conditions when processing my discharge.  I struggled for many years until finally getting a full diagnosis from not only the VA, but also from outside medical providers.  I was clearly unfit for military duty for many reasons (back pain, PTSD, depression, anxiety and bulimia).  This was all diagnosed at River Oaks Hospital in New Orleans, LA, while I was still on active duty (May-June 2004).”

Her complete submission is at Exhibit A.

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 LBP condition is addressed below.  The requested posttraumatic stress disorder, depression, anxiety and bulimia conditions were not identified by the PEB, and thus are not within the DoDI 6040.44 defined purview of the Board.  No additional 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 IPEB – Dated 20040430 | VA - based on Service Treatment Records (STR)
Condition | Code | Rating | Condition | Code | Rating | Exam
Chronic Subjective Low Back Pain… | 5299-5237 | 10% | Chronic Low Back Pain | 5299-5237 | 0% | STR
Other x 0 (Not in Scope) | Other x 0 | STR
Rating:  10% | Combined:  0%
Derived from VA Rating Decision (VARD) dated 20050418.

ANALYSIS SUMMARY:

Low Back Pain Condition.  The CI presented with LBP and bilateral hip pain after a 12-mile march in 1999.  She was treated with rest and anti-inflammatory medications.  In 2000 she underwent physical therapy without pain resolution.  Over the course of 3 years, the CI continued to report LBP with bilateral hip pain.  A computed tomography (CT) evaluation dated 16 July 2003 demonstrated a small disc bulge at the lumber 4-5 level without significant compression of the spinal cord or nerve roots (canal or neural foramina narrowing).  The CI was continued on pain medications and an alternate physical fitness test event.  A magnetic resonance imaging study dated 4 March 2004 revealed early spinal arthritis (facet arthropathy within the lower lumbar spine with compromise of the neural foramina at the lumbosacral [L5-S1] level secondary to the hypertrophic changes).  A neurosurgical consultation dated 17 March 2004 noted a history of localized LBP.  The examiner recommended an epidural steroid injection or another course of physical therapy.  The chronic LBP persisted despite conservative management and the CI was referred to the MEB.  At the narrative summary the CI reported a burning sensation in the low back.  The pain was relieved by rest and some walking.  The physical examination was significant for pain at the end of thoracolumbar motion (forward flexion to 100 degrees with pain at 90 degrees, combined range-of-motion with pain limitation of 240 degrees).  The neurologic and musculoskeletal examinations were otherwise normal.  There was no documented localized tenderness.  The CI did not report for her VA Compensation and Pension examination.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB adjudicated the chronic subjective LBP, without neurologic abnormality condition as unfitting.  The PEB and VA rated the LBP condition analogous to lumbosacral strain, coded 5299-5237; with a rating of 10% and VA rating of 0%.  The Board considered whether there was evidence for a higher than 10% rating for the LBP condition.  There was no evidence of radiculopathy.  There was no evidence of muscle spasms, abnormal spinal contour, abnormal gait, or limitation of forward flexion between 60-85 degrees for a 20% disability rating.  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 subjective LBP, without neurologic abnormality condition.  The Board concluded therefore that this condition could not be recommended for additional disability rating.

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 chronic subjective low back pain, without neurologic abnormality 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130909, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
XXXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAMR-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 XXXXXXXXXXXXXXX, AR20150004175 (PD201301252)

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						     XXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA

PD-2013-01252