RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00060
BRANCH OF SERVICE: Army 	SEPARATION DATE:  20040722	

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated Reserve E-5 (AUTOMATED LOSGISTICS SPECIALIST) medically separated for a back condition.  The back could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “chronic low back pain,” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The Informal PEB adjudicated “chronic back pain, s/p L5-S1 micro-discectomy,” and “left L5 radiculopathy” as unfitting, rated 10% and 10% respectively, with likely application of the US Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI appealed to the Formal PEB (FPEB), which affirmed the PEB’s findings and ratings.  A USAPDA review also affirmed the PEB.  The CI made no further appeals and was then medically separated.  

CI CONTENTION:  The CI contends for his unfitting back.  The applicant’s 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 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:  

FPEB - Dated 20040317	VA* - (~8 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5243	10%	Lumbar Post Laminectomy Syndrome…For L5-S1 HNP	5243	20%	20031209	
Left L5 Radiculopathy	8599-8520	10%	Radiculopathy, LLE	8699-8620	10%	20031209	
Other MEB/PEB Conditions X 0 (Not In Scope)	Other X 6	
RATING:  20%	RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20040907 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

CHRONIC BACK PAIN. The CI reported a history of low back pain (LBP) with onset while deployed which lead to an MRI dated 18 December 2002.  This showed a herniated disc at L5-S1 with impingement of the left S1 nerve root.  He was referred to neurosurgery and determined to need a CT myelogram.  This was accomplished on 20 March 2003 and confirmed the herniated disc at L5-S1.  The CI then had surgery on 2 April 2003 which included removal of a disc fragment which impinged on the nerve root.  The CI initially did well after surgery, but reported recurrent pain at the postoperative visit on 10 June 2003.  An MRI on 25 June 2003 demonstrated scarring at the surgical site.  Despite medications, steroid injections, and duty restrictions, he continued to have significant pain which precluded return to full duty.  He was issued a permanent L3 profile and referred for MEB.  The narrative summary (NARSUM) was dated 29 October 2003, 9 months prior to separation.  The CI reported the onset of pain in June 2002 while moving duffle bags.  He reported ongoing pain down the left leg and into the left foot.  He also reported numbness of the left foot.  On examination, the left leg was weaker than the right and sensation decreased in an S-1 distribution on the left.  He had difficulty with toe walking on the left.  Provocative testing for nerve root irritation was positive.  At the VA Compensation and Pension (C&P) examination performed on 9 December 2003, 8 months before separation, the CI reported constant pain which radiated to the left leg.  He noted that he was recommended bed rest as often as 1 day a month, but it was also recorded that he had lost 1 year of time from work since onset (18 months earlier).  This is not supported by the records in evidence.  He stated that he was able to garden and push a lawnmower.  He was noted to be in no acute distress and to have a normal posture and gait.  Provocative testing for nerve root irritation was negative and he denied radiation of pain.  The neurological examination was normal.  Tenderness was present, but spasm was not.  The goniometric range-of-motion (ROM) was limited by pain, but additional limitation with repetition not recorded.  Signs of intervertebral disc syndrome were noted to be present but not specified.  The Board noted that the episodes of incapacitation were not recorded.  A pain management note on 14 January 2004 noted that the CI had a series of epidural blocks (for pain and inflammation of the nerve root), implying at least temporary benefit as these are not continued if ineffective.  He was again seen on 9 March 2004 and it was noted that the 20 pound limitation in lifting would likely be long standing.  An MRI on 5 May 2004 was stable from that done the prior June (above).  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.  The Board noted that the ROM values below were consistent with those measured 10 years later at the C&P on 9 January 2014, increasing their validity.  

Thoracolumbar ROM
(Degrees)	PT ~8 Mo. Pre-Sep	VA C&P ~8 Mo. Pre-Sep	
Flexion (90 Normal)	85	70	
Combined (240)	210	220	
Comment	Limited by pain; no decrease with repetition	DeLuca + for pain, but additional limitation not stated	
§4.71a Rating	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition at 10%, coded 5243 (intervertebral disc syndrome).  It also rated the CI at 10% for left L5 radiculopathy, coded analogously as 8599-8520 (mild incomplete paralysis of the sciatic nerve).  The VA rated the back at 20%, also coded 5243.  It also rated the radiculopathy at 10%, coded 8620 (neuritis of the sciatic nerve).  The Board considered the evidence.  The ROM measured on both the PEB and VA examinations supports no more than a 10% rating.  There was no documented incapacitation or abnormal gait from spasm or guarding to support a higher rating.  The VA applied DeLuca, but the examiner did not actually cite a further limitation in the ROM from DeLuca.  A further limitation from pain was opined, but the measured limitation was from pain as well and the CI was limited in flexion to the onset of pain.  The Board reviewed this carefully and concluded that this is more likely simply imprecise writing rather than an indication of a further decrease in motion which would support the higher rating adjudicated by the VA.  As noted, the ROM remained stable when re-measured 10 years after separation.  The Board also considered the radicular pain, but noted that the neurological examination was normal on the VA C&P and the gait as normal.  This supports no more than a mild impairment which corresponds with the rating assigned by both the VA and PEB.  While different coding variations were chosen, neither offers a rating advantage to the other and both are equally appropriate for the pathology.  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 pain and lumbar radiculopathy conditions.  

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 chronic back pain and mild left L5 radiculopathy conditions, 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 20131222, 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 XXXXXXXXXXXXXXXXXXX, AR20160000323 (PD2014500060)

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