RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXXX	 CASE:  PD-2014-00388	
BRANCH OF SERVICE:  Army	 SEPARATION DATE:  20071118

SUMMARY OF CASE:  Data extracted from the available evidence of records reflect that this covered individual (CI) was an active duty E-4 (Armament Repairer) medically separated by Informal Physical Evaluation Board (IPEB) for low back pain, rated 10%.   

CI CONTENTION:  The CI contends that the Army refused to give him an MRI to determine the cause of his back pain and that the VA later conducted an MRI and determined that the real cause was two herniated discs.  The 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 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 –20070831	VARD - based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain, Without Neurologic Abnormality	5299-5237	10%	Scoliosis (Low Back Pain)	5237	0%*	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	
Derived from VA Rating Decision (VARD) dated 20100721. VARD dated 20100923 increased his rating to 10% effective 20100520.

ANALYSIS SUMMARY:  

Chronic Low Back Pain Condition.  According to service treatment records and the MEB narrative summary (NARSUM), the CI began to experience the gradual onset of low back pain during his deployment in 2006.  In January 2007 his back pain worsened after a period of increased physical training activities at which time it began to interfere with his performance.  He underwent conservative treatment and physical therapy and was provided a home therapy program which helped with his pain only initially.  Radiographic studies in April 2007 demonstrated scoliosis at the L2 interspace (12 degrees concave right) and at T8 (13.2 degree concave left).  The findings were otherwise unremarkable and there was no surgical indication.  Despite treatment, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and was referred for a Medical Evaluation Board (MEB).

At his initial physical therapy (PT) evaluation on 14 May 2007 (6 months prior to separation) the CI complained of intermittent symptoms in his lower extremities (more often right than left) provoked by running.  Examination noted the known scoliosis.  Muscle spasm or guarding was not mentioned.  There was painful motion and “mild limitation” in forward flexion with reach to ankles.”  A test of nerve root irritation was negative.

At an outpatient visit on 14 June 2007 (5 months before separation), the CI endorsed back pain only and denied lower extremities symptoms suggestive of radiculopathy.  Pain was exacerbated by running.  Painful motion and “full range of motion” of the spine were present on examination.  Scoliosis was noted in the thoracic spine region, but muscle spasm or guarding was not mentioned.  Gait was normal, a test of nerve root irritation was negative and a neurological exam was normal.  At the MEB examination (recorded on DD Form 2807 and 2808) dated 27 July 2007, 4 months prior to separation, the CI denied numbness or tingling, or impaired use of legs.  Physical exam showed tenderness to palpation along the lower thoracic and lumbar spine regions.  Examination showed “Full ROM” (range of motion), painful motion and no spasm.

The narrative summary (NARSUM) physical examination on 20 August 2007 (3 months prior to separation) observed that ROM testing was associated with minimal discomfort; however ROM was also stated to be “limited by pain and guarding.”  Lumbar tenderness was present.  Goniometric ROM testing revealed thoracolumbar flexion of 65 degrees (normal 90 degrees) and combined ROM of 205 degrees (normal 240 degrees).  A test for nerve root irritation was negative.  The exam was silent regarding gait, spinal contour or muscle spasm.  Review of the STR found no record of physician-prescribed bed rest.  There were no VA exams performed proximal to the date of separation.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the analogous 5237 code (lumbosacral strain), citing thoracolumbar motion limited by pain.  The PEB determined that his condition existed prior to service (EPTS) but that that it was permanently aggravated by military service.  There was no deduction.  The Board agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) or for combined ROM (greater than 120 degrees but not greater than 235 degrees) reported on the NARSUM exam.  There was no muscle spasm or guarding severe enough to result in abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  The Board also deliberated if additional disability was justified for possible lower extremity radiculopathy.  The CI complained of some lower extremity symptoms at a PT visit.  However, there was no evidence of nerve root irritation or muscle weakness on any exam.  The presence of functional impairment with a direct impact on fitness is the key determinant in the Board’s decision to recommend any condition for rating as additionally unfitting.  There is no evidence in this case of functional impairment attributable to peripheral neuropathy.  While the CI may have experienced radiating pain, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  The Board concluded there was no evidence of functional impairment on the basis of radiculopathy, and that additional disability was therefore not justified on this basis.  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 low back pain 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.  In the matter of the chronic low back pain 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.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140110, 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 XXXXXXXXXXXXXXXXXXXXXXX, AR20160002136 (PD201400388)

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