RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00315
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060306

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Food Service Operations, medically separated for “chronic low back pain” with a disability rating of 10%.

CI CONTENTION:  The CI made no specific contention in his application.  The CI’s complete submission is at Exhibit A.

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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:

SERVICE PEB - 20060124	VARD - 20060428	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Lumbosacral Spondylolysis 	5299-5239	40%	20060414	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:

Low Back Pain (LBP).  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the LBP began in 1995 after a motor vehicle accident.  Radiographic testing showed disc abnormalities at multiple levels of the lumbar spine.  Surgical intervention was not recommended.  The CI was treated with medication, physical therapy and other conservative therapeutic measures.  Despite treatment, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and he was referred for an MEB.  The MEB forwarded “lumbar disc herniation and degenerative disc disease resulting in low back pain” for Physical Evaluation Board (PEB) adjudication.

At the MEB NARSUM examination in September 2005, 6 months before separation, the CI reported severe LBP which was worse with movement.  On physical examination the CI walked with a cane.  He had lumbosacral spine tenderness and pain with straight leg raise.  His strength was 5/5 with intact sensation in both legs.  The only range of motion (ROM) finding cited was flexion 70 degrees (normal 90) with painful motion.

During the VA Compensation and Pension (C&P) examination in April 2006, 1 month after separation, the CI reported limitations with lifting, pushing, pulling and difficulty kneeling, squatting, and stooping.  He was able to manage his personal hygiene without assistance.  On physical examination there were no gross deformities or neurological deficits.  He walked with a mild limp and was using a cane.  He was able to tandem toe and heel walk without difficulty.  The ROM was flexion 30 degrees and combined ROM 80 (normal 240).  The examiner opined that the CI did not have evidence of radiculopathy to lower extremities.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating coded 5237 (lumbosacral strain), citing range of motion limited by pain.  The VA assigned a 40% rating analogously coded 5299-5239 (spondylolisthesis or segmental instability) based on the C&P examination citing forward flexion limited to 30 degrees.

The Board noted the disparity between the aforementioned ROM examinations and deliberated their probative value.  The Board determined the C&P examination had less probative value since the ROM examination was not supported by the evidence.  The Board found no evidence that the CI experience thoracolumbar trauma from the time of the MEB NARSUM examination (6 months before separation) to the C&P examination to corroborate a 30 degrees flexion.  During the VA examination, the CI was able to tandem toe and heel walk without difficulty.  There were no findings of muscle spasm or guarding severe enough to result in abnormal gait or abnormal spinal contour.  Conversely, the CI reported managing his personal hygiene without assistance, such as:  dressing, putting on shoes, bathing/showering or sitting on toilet which would be evidenced with a 30 degrees flexion.  The VA examiner wrote: “The veteran’s joint range of motion and strength are diminished due to a complaint of pain on attempt at repetitive motion testing, the extent and degree of which is not possible to determine due to the extreme subjectivity of the exercise.”

The Board determined based on the totality of the evidence that the MEB NARSUM examination (flexion at 70 degrees) had more probative value and was indicative of the CI’s spine disability at separation.  IAW the VASRD §4.71a, a 10% rating is warranted when thoracolumbar flexion is greater than 60 degrees, but not greater than 85 degrees.  The CI did have an abnormal gait, but there was insufficient evidence that his abnormal gait was due to muscle spasm or guarding to warrant a 20% rating.  There was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula or evidence of ratable peripheral nerve impairment which would provide for additional rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (resolution of reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication of the chronic LBP condition.

BOARD FINDINGS:  In the matter of the chronic low back pain, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  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 20140106, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

26AUG2016

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, AR20160010333 (PD201400315)

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