RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD1300501
BRANCH OF SERVICE:  Army	BOARD DATE:  20131127
SEPARATION DATE:  20070527

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (92F/Petroleum Supply Specialist) medically separated for low back pain (LBP).  The CI reported that her back pain started in 2003 after receiving an epidural block injection delivering a child.  The condition, which was treated conservatively (electronic stimulation, physical and chiropractic therapy, etc), could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or physical fitness standards so  she was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The back condition, characterized as “chronic refractory low back pain…,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded three other conditions (see rating chart below) for PEB adjudication.  The PEB adjudicated “chronic low back pain…” as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).   The remaining conditions were determined to be not unfitting.  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI wrote only “none at this time” in Block 3 of her DD-294 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.  In addition, the CI was notified by the Army that her case may eligible for review of the military disability evaluation of any mental health (MH) condition in accordance with Secretary of Defense directive for a comprehensive review of Service members who were referred to a disability evaluation process between 11 September 2001 and 30 April 2012 and whose MH diagnoses were changed or eliminated during that process.  Since the CI responded to this mailing, it is presumed that she has elected review by the PDBR for the MH condition, although she did not specifically contend for it on the DD Form 294.  In accordance with Secretary of Defense directive for a comprehensive review of mental health diagnoses that were changed during the Disability Evaluation System (DES) process, the applicant’s case file was reviewed regarding diagnosis change, fitness determination, and rating of unfitting MH diagnoses in accordance with the VASRD §4.129 and §4.130.  The CI is also eligible for PDBR review of other conditions evaluated by the PEB and has elected review by the PDBR.  The rating for the unfitting low back condition and any MH conditions are addressed below; 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 PEB – Dated 20070405	VA - (3 Days Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5237	10%	Chronic Low Back Pain with Disk Disease	5237	10%	20070530	
Chronic Bilateral Hip Pain
	Not Unfitting	Right Hip Pain	5099-5024	10%		
		Left Hip Pain	5099-5024	10%		
Chronic Low-Grade de Quervain’s Tenosynovitis		De Quervain Tenosynovitis, Bilateral Wrists	5024	0%		
Chronic Intermittent Pelvic Pain		Pelvic Pain	7699-7629	0%		
No Additional MEB/PEB Entries	Other x 5		
Combined:  10%	Combined:  40%	
Derived from VA Rating Decision (VARD) dated 20070919).

ANALYSIS SUMMARY:

Low Back Condition.  At the narrative summary exam on 27 November 2006, the CI reported a constant LBP with possible radiation to the hips.  She noted an inability to comfortably run, jump, march or do sit-ups.  The examiner noted that an evaluation by a spine specialist identified no surgical indication.  Physical examination showed no evidence of non-physiologic pain.  Straight leg raise testing for radiculopathy was negative and lower extremity strength was normal.  Lumbar X-rays were normal, and a magnetic resonance imaging study 2006 showed “very minor disk disease” at L3 through S1.  An orthopedist examiner on 8 January 2007 indicated that the pain was localized to the lumbar midline and did not radiate.  There was no associated lower extremity numbness, tingling or weakness.  Examination noted that lumbar flexion brought fingertips to twelve inches from the floor, and extension was approximately 30 degrees.  There was no scoliosis or muscle tenderness, and muscle tone was normal.  Pain at extreme extension was reported.  At the VA Compensation and Pension (C&P) exam performed 3 days after separation, the CI reported daily LBP.  “Pins and needles” sensation radiated to the hip area.  “One episode of incapacitation” reportedly occurred in 2005, but details were not provided.  Examination revealed a normal gait and spinal contour.  Repetitive range-of-motion (ROM) showed no additional functional loss.  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)	MEB ~6 Mo. Pre-Sep	VA C&P 3 days Post-Sep	
Flexion (90 Normal)	75 (73 70 75)	75	
Extension (30)	25 (24 21 23)	20	
R Lat Flexion (30)	25 (26 25 26)	25	
L Lat Flexion (30)	20 (21 20 22)	20	
R Rotation (30)	15 (16 17 16)	30	
L Rotation (30)	10 (14 17 12)	25	
Combined (240)	170	195	
Comment	+tenderness; no spasm	No tenderness, spasm or guarding	
§4.71a Rating	10%	10%	

The Board directs attention to its rating recommendation based on the above evidence.  The PEB and VA each assigned a 10% rating under the 5237 code (lumbosacral strain; analogously by the PEB).  Board members agreed that the service and VA exams justified a 10% rating based on limitation of flexion and limitation of combined ROM.  The Board also considered whether a higher rating could be achieved under the formula for rating intervertebral disc disease based on incapacitating episodes.  However, the minimum rating under that formula was not met.  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 low back pain condition.

Contended PEB Conditions.  As previously elaborated, it is presumed that the CI has elected review by the PDBR for a MH condition, although she did not specifically contend for one on the DD Form 294.  A record review shows that on the MEB physical (DD Form 2807), the CI wrote that she “worried about the next day” when she was experiencing trouble sleeping, and worried “about my soldiers and how their lives and family are.”  However, careful review of the entire service treatment record found no MH diagnosis in evidence.  The Board determined therefore that no MH diagnoses were changed to the applicant's possible disadvantage in the disability evaluation process, and thus this applicant did not meet the inclusion criteria in the Terms of Reference of the MH Review Project.  The Board likewise determined that there was no indication from the record that any MH condition significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a determination of unfit for any MH condition; and, therefore, no additional disability rating can be recommended.

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 LBP condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of any contended MH condition, the Board unanimously recommends no additional disability rating.  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	5299-5237	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130513, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

xxxxxxxxxxxxxxxxxxxx, DAF
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 xxxxxxxxxxxxxxxxxxxxxxxxxxxx, AR20140003609 (PD201300501)

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						     xxxxxxxxxxxxxxxxxxxxxxxxx
						     Deputy Assistant Secretary
						         (Army Review Boards)