RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-01482
BRANCH OF SERVICE:  Army	BOARD DATE:  20141022
SEPARATION DATE:  20040624

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (31S10/Satellite Communications System Operator) 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 or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The lower back condition, characterized as “chronic low back pain with mild recess stenosis of L4/L5 and a congenitally small lumbar spinal canal” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded a “hypercholesterolemia” condition.  The Informal PEB adjudicated “chronic low back pain with mild recess stenosis of L4/L5 and a congenitally small lumbar spinal canal,” as unfitting, rated 0%.  The hypercholesterolemia condition was determined to be not disqualifying.  The CI made no appeals and was medically separated.

CI CONTENTION: “1. ER Reports 2. Neurological Report 3. Clinic Report 4. Chiropractic Clinic Report.”

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; 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 of Corrections of Military Records.

RATING COMPARISON:

Service IPEB – Dated 20040423	VA – (51 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Lower Back Pain with Mild Recess Stenosis of L4/L5 and a Congenitally
Small Lumbar Spinal Canal	5237	0%	Lumbar Facet Disease (Claimed as Degenerative Arthritis
of the Spine and Chronic Low Back Pain)	5242	0%	20080904	
Other x 1 (Not in Scope)	Other x 0	
Combined:  0%	Combined:  10%	
Derived from VA Rating Decision (VARD) dated 20081017 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Chronic Lower Back Pain.  The narrative summary (NARSUM) notes the CI developed back pain without trauma in July 2003.  Routine X-rays of the back dated 22 July 2003, were normal.  A magnetic resonance imaging (MRI) of the back performed on 23 October 2003 revealed a mild, broad-based disc without herniation in the low back and very mild spinal stenosis with mild bilateral nerve encroachment.  The CI was treated for pain control with various major narcotic medications from multiple pain clinics.  The CI was seen by neurosurgery on 11 November 2003.  On examination the CI was in no distress with normal gait.  On examination of the back neither scoliosis nor muscle spasm was noted.  Flexion was decreased with complaints of lower back and buttocks pain.  Motor, sensory and reflex examinations were normal.  Surgery was not recommended.  The CI was seen by a second neurosurgeon on 19 November 2003.  On examination the CI was noted “not to be in a lot of pain.”  Gait was “slightly stiff.”  Motor, sensory and reflex exams were normal.  No back spasms were recorded.  The neurosurgeon reviewed the MRI and opined “lumbar spine is really unremarkable to me.  I see no disk or significant spinal stenosis.”  He further noted that “he has chronic low back pain of ill-defined etiology, possibly soft tissue.  It appears to me that his complaints are out of proportion to his physical and MRI findings.  I feel he does not have a neurosurgical problem and surgery is not recommended.”  On 15 December 2003, the CI presented to the clinic having discontinued this treatment in Pain Management.  He requested that his PCM treat his chronic pain and was begun on an extremely strong pain medication.

On the MEB NARSUM exam performed on 11 March 2004, 3 months prior to separation, the CI reported back pain radiating to his legs.  The MEB physical exam noted the CI to have a normal gait and to move on and off the exam table without problem.  Motor, sensory and reflex examinations were normal without spasm or back tenderness.  On physical therapy evaluation for the NARSUM performed on 18 March 2003, range-of-motion (ROM) of the back was normal without pain.  At the VA Compensation and Pension exam performed 51 months after separation, the CI was working as a service technician.  He reported no incapacitation from his back condition and no interference with daily activities, but with pain at work if he has to carry heavy objects.  ROM was normal with pain reported at end flexion and extension.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the back pain condition 0% using different codes; the PEB used code 5237 (lumbosacral strain) and the VA used code 5242 (degenerative arthritis).  IAW §4.71a, a higher rating of 10%, under these codes, requires forward flexion of the thoracolumbar spine greater than 60 degrees, but not greater than 85 degrees.  The Board unanimously agreed that the evidence in record did not support a compensable rating for the back condition under the Veterans Affairs Schedule for Rating Disabilities (VASRD) ROM criteria.  The Board considered a rating for pain IAW §4.59 (painful motion).  The Board noted the frequent reports of the CI of severe back pain and, multiple visits to pain clinics requiring narcotic medication.  The Board unanimously agreed that this was influenced by social and behavioral factors and was not considered by the Board.  The Board unanimously agreed the preponderance of clinical evidence in record did not support the back condition to rise to the level of 10% rating.  The Board considered a rating under code 5243 (incapacitating episodes, intervertebral disc syndrome).  An incapacitating episode is defined as a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed and treated by a physician.  The record documents no incapacitation under this definition in the 12-month period prior to the MEB examination.  The Board agreed that no rating could be recommended under this code.  The Board considered a rating IAW §4.123 (neuritis, peripheral nerve).  The Board agreed there was no evidence for ratable peripheral nerve impairment in this case, since no motor weakness was present, nerve conduction studies were negative and sensory symptoms had no functional implication.  The Board found no other appropriate codes for consideration.  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 back 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 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 20130915, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		

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, AR20150004307 (PD201301482)

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						     
						         
CF: 
(  ) DoD PDBR
(  ) DVA