RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00423
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050815

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Radio and Communications Security Repairer, medically separated for “chronic low back pain,” with a disability rating of 0%.  

CI CONTENTION:  The applicant asserts he continues to have issues with lower back pain and conservative treatment has not helped.    The applicant’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 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 - 20050701	VA - 20060210	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	0%	DJD of Lumbosacral Spine	5242	10%	20051221	
Combined RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain Condition.  According to service treatment records and the MEB narrative summary (NARSUM), the CI developed low back pain (LBP) that radiated to the right buttock the day after moving heavy boxes, without any specific trauma noted.  The pain was initially limited to these areas, but the CI eventually reported intermittent right lower extremity (RLE) symptoms of pain and paresthesias (abnormal sensory disturbances often numbness and tingling - N/T).  Magnetic resonance imaging (MRI) studies October 2004 showed degenerative disc disease with bilateral foraminal narrowing at lower lumbar levels and facet joint arthritis at L4-5, without central spinal canal stenosis.  At an orthopedic consultation on 7 December 2004, the CI reported LBP with sharp “stabbing” right buttock pain, graded 5-7/10, with intermittent N/T in his RLE.  The physical exam noted a “slightly” flexed forward posture.  The examiner described range-of-motion (ROM) as “decidedly poor in flexion, extension, bending and rotation, which is uncomfortable” and indicated the straight leg raise test (SLR, tests for nerve tension) was “probably positive”, at 65 degrees on the right.  Lower extremity strength and reflexes were normal.  The orthopedic assessment was sciatica due to intervertebral disc disease and a trial of epidural steroid injections (ESI) was recommended before consideration of surgery.  The CI had three ESIs, with only temporary improvement in his symptoms.  Despite treatment, the CI’s back condition could not be adequately rehabilitated to meet the physical requirements of his military specialty.  There were no periods of physician prescribed bed rest documented in record.

At the MEB orthopedic (ortho) consult on 31 May 2005 (3 months prior to separation) the CI reported persistent LBP, graded 5/10, and RLE pain that was increased by activity, without current N/T or any bowel or bladder symptoms.  The physical examination noted normal LE strength, sensation, and reflexes and negative SLR.  The CI was able to heel and toe walk without difficulty.  Lumbar ROM was described as “hands 24 inches from the floor” (per examiner approximately 50 degrees).  

At the MEB NARSUM examination on 16 June 2005, performed 2 months prior to separation, the CI reported constant right buttock pain, and intermittent RLE pain and N/T.  The physical exam noted a normal gait.  There was no tenderness to palpitation (TTP) or muscle spasm.  Lower extremity strength, sensation, and reflexes were normal and SLR was negative.  The CI was able to heel and toe walk without difficulty.  The goniometric ROM (three repetitions) was flexion of 60 degrees with a combined ROM of 200 degrees, with painful motion and there was no decrease in ROM after 3 repetitions. 

At the VA Compensation and Pension (C&P) General medical examination on 21 December 2005, performed 4 months after separation, the CI reported intermittent right buttock pain, aggravated by activity, without radiation or flare-ups.  The physical exam showed a normal gait, without weakness, spasms or TTP.  The ROM was forward flexion of 82 degrees with a combined ROM of 200 degrees, with painful motion noted.  After repetition there was no additional loss of ROM, fatigue, impaired endurance, or weakened movement.  Lumbar spine X-rays 21 December 2005 showed degenerative joint disease.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 0% coded 5237 (lumbosacral strain), citing ROM limited by pain alone.  The VA rated the back condition 10% coded 5242 (degenerative arthritis of the spine), citing limitation of forward flexion.  The Board noted that the evidence at the MEB orthopedic consult and the MEB NARSUM exams supports a 20% rating based upon limitation of flexion (greater than 30 degrees but not greater than 60 degrees), whereas, the post-separation C&P exam supports a 10% rating.  The Board discussed how to reconcile the difference between the exams.  The MEB orthopedic consult, MEB NARSUM and C&P exams were all of similar proximity to the date of separation and the Board judged that all three were valid exams.  However, after deliberations, Member consensus was that IAW VASRD §4.7 (Higher of two evaluations) the total evidence supports that the disability due to the back condition was more closely approximated by the 20% rating criteria, than the 10%, and there was no evidence of TL flexion of “30 degrees or less” to support the next higher 40% rating.  Although the CI had intervertebral disc disease there were no incapacitating episodes requiring bed rest prescribed by a physician to warrant consideration of rating under the alternate VASRD formula based on incapacitating episodes due to intervertebral disc syndrome.  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 chronic low back pain condition, coded 5242.  
The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  Prior to separation, the CI was treated with ESIs for lumbar radiculopathy and at the MEB ortho consult and the MEB NARSUM examinations the CI reported intermittent radiating RLE pain with paresthesias.  However, examinations indicated normal LE strength, reflexes and gait, and no fixed sensory deficits.  By the time of the post-separation C&P exam the CI reported pain located in the right buttock, but not radiating to the entire RLE.  Radiating pain from the back condition is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates)” and there is no evidence in this case that a LE motor or sensory deficit existed to any degree that could be described as functionally impairing.  The Board therefore concluded that additional disability rating was not justified on this basis.  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 chronic low back pain condition, coded 5242.  

BOARD FINDINGS:  In the matter of the chronic low back pain condition, the Board unanimously recommends a disability rating of 20%, coded 5242 IAW VASRD §4.71a.  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	
Chronic Low Back Pain 	5242	20%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140103, 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 XXXXXXXXXXXXXXXXXX, AR20160005524 (PD201400423)

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, accept the Board’s recommendation to modify the individual’s disability rating to 20% without re-characterization 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