RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01999
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050812

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6 (Field Artillery Auto Tactical Data System Specialist) medically separated for a back condition.  The back 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 MEB forwarded “chronic back pain with herniated disc at L4/L5 and L5/S1 with radiculopathy” to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic subjective back pain…without neurologic abnormality…” with likely application of AR 635-40.  The CI made no appeals and was medically separated. 

CI CONTENTION:  The CI made no specific contention in his application.  His 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 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 20050720	VA* - (~6 Mos. Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Subjective Back Pain…without Neurologic Abnormality	5243	10%	DDD (L4-L5 and L5-Sl) and Chronic Lumbar Sprain/Strain	5242	10%	20060131	
			Lumbar Radiculopathy, RLE	8520	10%	20060131	
			Lumbar Radiculopathy, LLE	8520	10%	20060131	
			Lumbar Radiculopathy, LLE	8520	10%	20060131	
Other MEB/PEB Conditions x 0 (Not in Scope)	Other x 0	
RATING:  10%	COMBINED RATING: 40%	
*Derived from VA Rating Decision (VARD) dated 20060706 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Chronic Subjective Back Pain Without Neurologic Abnormality.  The record showed that the CI was first seen for low back pain (LBP) on 11 March 2003 after he injured his back while doing jumping exercises in physical fitness the day prior.  The examination showed some pain with motion and extension limited to 20 degrees (normal is 30), but was otherwise unremarkable.  He was treated with medications and duty restrictions, but his pain persisted.  He was referred to physical therapy (PT) and then seen periodically for recurrent LBP over the next 2 years.  When documented, the range-of-motion (ROM) was uncomfortable (or painful), but typically normal or near normal.  On 31 January 2005, 6 months prior to separation, he was again seen in PT for increased symptoms and referred for an MRI.  This was done a week later and showed a herniated disc at L4-5 and L5-S1 with nerve impingement.  He was evaluated in neurosurgery on 15 March 2005 and noted to have flexion reduced to 60 degrees and extension to 10 degrees with positive provocative testing for nerve root irritation.  Surgery was discussed, but the CI declined as the success rate was around 15%.  He was next seen in orthopedics 2 weeks later.  The ROM was again reduced with flexion to his knees and extension decreased to 70% of normal (equates to 9 degrees).  The neurological examination, gait, and posture were normal.  Electrodiagnostic studies on 11 April 2005 showed a left and right L5S1 radiculopathy.  The narrative summary (NARSUM) was dated 18 May 2005, 3 months prior to separation.  The CI reported that his LBP had actually started while golfing in 1998, but was tolerable until the injury in 2003 described above.  He was noted to have a normal gait and neurological examination.  The ROM values were identical to those obtained in PT 2 days earlier and are charted below.  Provocative testing for nerve root irritation was positive bilaterally.  

At the VA Compensation and Pension (C&P) examination performed on 31 January 2006, 6 months after separation, the CI reported that he was working full time as an analyst and had lost no time from work.  On examination, he had a normal gait and posture without atrophy.  The neurological examination was normal other than abnormal sensation in the L5 and S1 distribution bilaterally.  The ROM was painful and reduced in flexion as charted below.  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)	PT ~3 Mo. Pre-Sep	VA C&P ~6 Mo. Post-Sep	
Flexion (90 Normal)	70	70	
Combined (240)	205	220	
Comment	Painful Motion	Painful Motion	
§4.71a Rating	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the back at 10%, coded 5243 (intervertebral disc syndrome) and 5242 (degenerative arthritis of the spine), respectively.  The VA also rated the CI at 10% each for left and right sided lumbar radiculopathy, coded 8520 (mild, incomplete paralysis of the sciatic nerve).  The Board first considered if the radiculopathy was separately unfitting.  The orthopedic and NARSUM examinations, 4 and 3 months prior to separation, respectively, both documented a normal neurological examination.  The VA C&P noted only sensory impairment and also noted that there was no time lost from work.  The evidence does not support a finding of an unfitting radiculopathy at separation.  The radiating pain is incorporated into the back condition and is not separately ratable.  The Board concluded therefore that this condition could not be recommended for additional disability rating.  A 10% rating is supported both by the limitation in motion and by painful motion.  The Board found no route to 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 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.  As discussed above, PEB reliance on AR 635-40 for rating the back pain was operant in this case and the condition was adjudicated independently of that regulation by this Board.  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 20131022, 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 XXXXXXXXXXXXXXXXXXXX, AR20150018684 (PD201301999)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA