RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2014-01150
BRANCH OF SERVICE:  Army	BOARD DATE:  20140815
SEPARATION DATE:  20070706

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (31B/Military Police [MP]) medically separated for a chronic low back pain (LBP) condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty but he could perform alternate physical fitness test.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The low back condition, characterized as “lumbago,” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The informal PEB initially adjudicated “chronic low back pain” as unfitting, rated 0%, but increased it to 10% after reconsideration, with likely application of the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions”

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; 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 20070706	VA - (4 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5237	10%	Lumbar Strain	5237	10%	20071126	
Other x 0 (Not in Scope)	Other x 4		
Combined:  10%	Combined:  40%	
Derived from VA Rating Decision (VARD) dated 20080215 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Low Back Pain Condition.  The service treatment record indicated the CI’s LBP began insidiously when he was in the Air Force in 2002.  He re-injured his back in October 2006 while lifting some light boxes.  The back pain resolved in 3 days, but he aggravated the condition during training.  The pain was noted in the mid to lower back in the midline with occasional episodes of pain in his right paraspinal region or down the right leg and was described as constant and dull at 3/10 (10 being the worst) with flares of a sharp stabbing-type of pain at 8-9/10.  Treatment consisted of physical therapy and chiropractic therapy with limited resolution of pain and medications including a non-steroidal anti-inflammatory agent and a narcotic.  X-rays of the CI’s lumbar spine were normal and the magnetic resonance imaging was likewise normal.  He was placed on quarters twice for 48 hours.  He was evaluated in orthopedics on 28 November 2006 and noted to have tenderness throughout the lumbar spine and painful motion.  His gait and stance were normal and spasm absent.  The sensory, motor and reflex examinations were normal.  He was placed on medical hold for evaluation of his LBP.  At the MEB examination dated 22 December 2006 and 6 months prior to separation, the CI reported difficulty sleeping due to recurring lower back pain.  He was noted to have pain with maneuvers not expected to be painful.  The commander’s statement dated 18 January 2007 indicated the CI was unable to perform his duties as an MP because of his medical condition, which required him to go on sick call, numerous appointments and his physical profile.  A physical therapy examination on 31 January 2007 noted that his gait was normal, spasm was absent and range-of-motion (ROM) was within functional limits.  The narrative summary was dated 28 March 2007.  The CI reported that he was not able to complete much of physical therapy due to pain.  The CI was advised his back pain did not warrant surgery.  On examination he ambulated without difficulty.  There was no visible or palpable deformity of the back.  The CI was noted to have pain above his spinous processes with light touch, pain with axial load and pain with hip rotation and was tender from the mid-thoracic spine to his low thoracic or upper lumbar spine in the midline.  These maneuvers are not expected to cause pain in this condition.  Flexion was limited by pain.  The examiner also noted the CI was unable to lie flat on the examination table.  The CI was issued a permanent L3 profile on 29 April 2007 for LBP, degenerative disc disease with restrictions to avoid “high impact” physical activities including military functional activities and physical fitness training.  At the VA Compensation and Pension examination performed on 26 November 2007, over 4 months after separation, the CI reported constant LBP for which he took a non-steroidal anti-inflammatory medication twice daily, and had flares two to three times per week relieved with a narcotic medication.  He had no incapacitating episodes.  Since separation, he had been employed full-time as a driver and had missed no work.  On examination, he had a normal gait and no difficulty rising from a chair.  He did not use an assistive device.  Examination of his back revealed a normal curvature without spasm.  The ROM is documented below.  The muscles had normal bulk and tone.  The sensory, motor and reflex examinations were normal.  The 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/PT ~3 Mo. Pre-Sep
(20070404) p.47	VA C&P ~4 Mo. Post-Sep
(20071126) p.#220	
Flexion (90 Normal)	80	80 w/pain on repetition	
Combined (240)	200	210	
Comment	No spasm, SLR negative, midline tenderness mid-thoracic to upper lumbar spine	Normal gait, tender to palpation L-4 midline area, no spasm	
§4.71a Rating	10%	10%	

The Board directs attention to its rating recommendation based on the above evidence.  The PEB and VA both assigned the CI a 10% rating using code 5237 (lumbosacral strain) for chronic LBP.  Spasm was absent, gait and contour were normal and the CI was on quarters for only 4 days in the 12 months prior to separation.  The Board found no route to support a higher 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 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 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 20140509, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

XXXXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXXXX, AR20150006241 (PD201401150)

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