RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-02592
BRANCH OF SERVICE:  Army	BOARD DATE:  20150401
SEPARATION DATE:  20060514

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Mental Health Specialist) medically separated for low back pain (LBP).  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 condition, characterized as “low back pain due to bulging disc at L4-5,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic back pain due to degenerative disc disease (DDD), without significant neurologic abnormality” as unfitting, rated 10%, with likely application of the Veterans Affairs 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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.

RATING COMPARISON:

IPEB – Dated 20060404 | VA* - Based on Service Treatment Records (STR)
Condition | Code | Rating | Condition | Code | Rating | Exam
Chronic Back Pain due to DDD without significant Neurologic Abnormality | 5299-5242 | 10% | DDD, L5-S1 with L4-5 Disc Bulge | 5243 | 10% | STR
| | | Left Lower Extremity Radiculopathy | 8520 | 10% | STR
Other x 0 (Not In Scope) | Other x 6
RATING:  10% | RATING:  60%
*Derived from VA Rating Decision (VARD) dated 20061227 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Chronic Back Pain Condition.  Absent discrete injury or precipitant, the CI first reported LBP while deployed in October 2004; and, the pain persisted throughout the balance of her service career.  The STR noted occasional complaints of radiating pain into her left leg, but no consistent radiculopathy was revealed.  Neurologically mediated motor examinations remained normal.  Radiologic examinations revealed multi-level bulging lumbosacral discs with mild nerve encroachment consistent with DDD.  Multiple treatment modalities within physical therapy were pursued, and a permanent profile was issued in March 2006.  In the absence of significant neurologic complications, surgery was not indicated.  Multiple entries in the STR document normal gait, normal lower extremity neurologic findings, grossly normal or modestly impaired range-of-motion (ROM); and, there was no documentation of incapacitation.

The narrative summary performed 7 weeks prior to separation; the CI endorsed daily LBP resulting in her inability “to perform her warrior tasks.”  Her physical examination revealed slightly less comparison sensation to left lower extremity.  Thoracolumbar ROM was normal excepting minimal decrease in extension at 25 degrees (normal 30 degrees).  Painful motion was present.  Her diagnosis remained LBP due to bulging lumbar disc.

The VA Compensation and Pension general medical examination was performed 13 months post separation where the CI reported constant LBP with lower extremity extension coupled with weakness and stiffness.  Aggravating factors included physical activities and relief was obtained with medication.  She denied periods of incapacitation, but endorsed the inability to run, hike, camp, or back pack.  The VA exam revealed a normal gait without assistive device.  No spasm was described, but lumbar tenderness and painful motion were present.  Neurological motor findings and thoracolumbar ROM parameters were normal.

The Board directed attention to its rating recommendation based on the above evidence.  Both the PEB and VA applied clinically compatible primary codes of 5242 (degenerative arthritis) and 5243 (intervertebral disc syndrome) to arrive at the same 10% rating under the VASRD §4.71a general rating formula for the spine.  There was no sufficient documentation for incapacitating episodes which would achieve a higher rating under 5243.  Absent compensable ROM, board members agreed that painful motion was clearly present both prior to and after separation to support a 10% impairment rating under VASRD §4.59.  Additionally, the Board agreed that the slight decrease in sensation of the left leg as found at the MEB exam coupled with normal neurologic findings at the VA exam did not constitute a separate ratable neuropathy for disability, since no functional impairment linked to fitness was in evidence.  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 of the lumbar spine 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 low back 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 20140529, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXX
President
DoD 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, AR20150015573 (PD201402592)

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-2014-02592