RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00301
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050213

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Transportation Management Coordinator) medically separated for low back pain (LBP).  The low back condition 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 LBP,” 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 subjective back pain due to degenerative disc disease (DDD)” as unfitting, rated 10%.  The CI initially appealed to a formal board, but later withdrew his appeal and was medically separated.  

CI CONTENTION:  The applicant makes 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 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 20040928	VA* - (~1 Mos. Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Subjective Back Pain 	5299-5242	10%	Intervertebral Disc Syndrome of Lumbar Spine	5243	10%	20050329	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 14	
RATING:  10%	RATING:  70%	
*Derived from VA Rating Decision (VARD) dated 20050609 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Low Back Condition.  The service treatment record (STR) indicated an exacerbation of non-radicular and atraumatic LBP in July 2001.  Historically, the [CI] complained of chronic LBP for years and remained throughout his Service career.  Initial radiographs revealed DDD and later, a herniation of L5-S1 with minimal nerve impingement.  Despite long term treatment of activity restrictions, medications, physical therapy (PT) and injections, his painful symptoms persisted.  He was permanently profiled in August 2004 with the diagnosis of chronic LBP as well as three other conditions and was referred to a MEB.  The MEB narrative summary (NARSUM) physical examination (PE) was performed on 25 February 2004 (12 months pre-separation) and revealed painful and decreased thoracolumbar range of motion (ROM).  Neuro-sensory parameters were normal.  There was no muscle spasm present.  The diagnosis remained chronic LBP.  The commander’s statement validated the CI’s inability to adequately perform his MOS required duties due to his physical conditions…including the back condition.  At the VA Compensation and Pension (C&P) examination (29 March 2005; 6 weeks post-separation), the CI reported a constant LBP described as ‘squeezing, sharp, and sticking’ in nature and worsened with activities.  The CI endorsed that he can function without medication and his condition does not cause incapacitation.  His functional impairment was noted as the inability to lift, bend, jump, run or exercise.   

His PE revealed an abnormal gait described as ‘limping’ and favoring the left leg.  Thoracolumbar ROM was decreased and painful.  Neuro-sensory examination of the lower extremity revealed decreased sensation on the top and outside of the left foot with motor weakness of the left great toe on a 4/5 scale.  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 ~12 Mo. Pre-Sep
(20040225) 	VA C&P ~6 weeks Post-Sep
(20050329) 	
Flexion (90 Normal)	50	60	
Extension (30)	20	30	
R Lat Flexion (30)	15	30	
L Lat Flexion (30)	25	30	
R Rotation (30)	30	30	
L Rotation (30)	30	30	
Combined (240)	170	210	
Comment	painful motion	painful motion; 	
§4.71a Rating	20%	20%	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB analogously coded the back condition under 5242 (degenerative arthritis) at 10% citing painful limitation whereas the VA also rated 10% under 5243 (intervertebral disc syndrome) citing limited motion.  Board members first agreed that sufficient evidence of painful motion was consistently in evidence to justify the rating of 10% IAW VASRD §4.59.  In considering the varying objective findings between the MEB and VA examinations; both equating to a VASRD 20% rating, Board members agreed that exclusive probative value be placed on the VA examination due to its reference date near separation.  Limitation of flexion at 60 degrees was clearly supported at 20% IAW §4.71a.  

Members then considered and deliberated whether a separately ratable neuropathy existed with functional impairment linked to fitness near the time of service separation.  Members concluded that in light of the CI having no subjective complaints of a lower extremity neuropathy at the VA exam, the objective evidence of decreased sensation confined to an area of the left foot with minimal motor weakness to a single toe did not meet criteria for concluding it was a separately unfitting condition, and therefore, cannot be recommended for additional disability rating.  Additionally, any pain component of a radiculopathy/neuropathy is subsumed under the general spine rating as specified in §4.71a.   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 low 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 low 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:  

CONDITION	VASRD CODE	RATING	
Back Pain Due To Degenerative Disc Disease	5243	20%	
COMBINED RATING	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140131, 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 XXXXXXXXXXXXXXXXXXXXXXXX, AR20160000207 (PD201400301)

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:

CF: 
(  ) DoD PDBR
(  ) DVA