RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-00048
BRANCH OF SERVICE:  Army	BOARD DATE:  20141202
SEPARATION DATE:  20061213

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty Army SSG/E-6 (L9K30/Armor Crewman) medically separated for a lumbar condition.  The lumbar 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 lumbar condition, characterized as “low back pain (LBP) with degenerative disk disease (DDD) after two procedures for L5-S1 herniated nucleus pulposus (HNP),” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded “residual pain and stiffness following left Achilles’s tendon repair” and “hypertension,” conditions as medically acceptable.  The Informal PEB adjudicated “low back pain with traumatic onset” as unfitting, rated at 10% with probable 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 elaborated no specific contention in his 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.  The rating for the unfitting lumbar 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 20070611	VA - (2 Mos. Post-Separation	
Condition	Code	Rating	Condition	Code	Rating	Exam	
LBP With Traumatic Onset	5243	10%	DDD, Lumbar Spine	5243	10%	20070227	
	Not Unfitting	No VA Entry	
Rating:  10%	Combined:  60%	
Derived from VA Rating Decision (VARD) dated 20070517 (most proximate to date of separation)

ANALYSIS SUMMARY:

Low Back Pain Condition.  The CI was first seen for LBP in 1997, almost 9 years prior to separation, and treated conservatively over the ensuing years.  On 23 November 2005, a magnetic resonance imaging (MRI) showed multi-level DDD with an L5-S1 HNP which impinged on the nerve root.  The CI subsequently underwent a discectomy (surgical removal of the disc) on 15 February 2006.  His symptoms persisted though and a repeat MRI showed congenital narrowing of the spinal canal in the lumbar region, scar tissue surrounding the right S1 nerve root, and a recurrent HNP.  He underwent a second operation on 27 July 2006.  Despite rehabilitation, he continued to have LBP and was entered into the MEB process.  The initial narrative summary (NARSUM) was dictated on 10 July 2006, 2 weeks before the surgical revision.  It was updated by an orthopedic surgeon on 19 October 2006, less than 3 months after the second operation and 2 months prior to separation.  The CI reported continued pain.  On examination, the CI walked, sat and stood well, muscle spasms were absent.  The neurological examination was normal other than hypersensitivity (to touch) above the right foot.  Heel and toe walk were normal.  The lumbar curvature was normal.  The range-of-motion (ROM) is captured in below chart.  

At the general VA Compensation and Pension (C&P) examination performed on 17 February 2007 (performed 2 months after separation), the CI reported that he rarely wore tie shoes or socks due to the difficulty bending his back.  His posture and gait were normal as was the neurological examination.  He was then seen specifically for the spine 2 weeks later.  He denied both incontinence and incapacitation, but reported periodic numbness bilaterally in the distribution of the sciatic nerve.  On examination, the gait and posture were normal; spasm, tenderness, and weakness were absent.  The neurological examination was normal.  The ROM captured in below chart.  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 ~2 Mo. Pre-Sep	VA C&P ~ 2 Mo. Post-Sep	
Flexion (90 Normal)	55	60	
Combined (240)	180	180	
Comment		DeLuca negative	
§4.71a Rating	20%	20%	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the back condition at 10% using the 5243 code for intervertebral disc syndrome.  The Board noted that the ROM supports a rating of 20% on both the PEB and the VA C&P examinations.  The Board found no route to a higher rating using any other available code.  The Board also noted the subjective sensory changes reported by the CI, but that the neurological examination was normal on both C&P examinations, which were more remote from surgery, and essentially normal on the NARSUM addendum.  The Board determined that there was not an unfitting neuropathy present at separation.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% 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, the Board unanimously recommends a disability rating of 20%, coded 5243 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Low Back Pain With Traumatic Onset	5243	20%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131217, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		XXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXX, AR20150007629 (PD201400048)

1.  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 to modify the individual’s disability rating to 20% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl		     XXXXXXXXXXXXXXX
		     Deputy Assistant Secretary of the Army
		         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA