RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE:  PD-2014-00436
BRANCH OF SERVICE:  Army		SEPARATION DATE:  20060822

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Active Duty E7, Professional Recruiter, medically separated for “low back pain” with a disability rating of 10%.

CI CONTENTION:  He was given a higher rating for his condition by the VA.  His 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 - 20060808	VARD – 20070314	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5242	10%	DDD L4 with Thoracic Muscle Spasm	5243	20%	20070110	
COMBINED RATING:  10%	COMBINED RATING FOR ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Chronic Low Back Pain.  The record showed the CI first reported low back pain (LBP) on 27 February 1995.  He denied trauma and was thought to have a strain.  He was seen several more times that year for LBP.  On 4 February 1998, he was in a helicopter mishap when the aircraft broke through ice.  He was a crewmember and was evaluated 3 hours later in the local emergency room.  His exam was normal without symptoms.  His next evaluation for LBP was on 10 October 1998 when he reported a 4-day history of pain without antecedent trauma.  He was seen periodically for LBP over the next few years.  On 3 October 2005, magnetic resonance imaging (MRI) revealed degenerative disc disease (DDD) at L4-5 and L5-S1.  His pain persisted but improved after receiving three separate steroid injections.  A discogram showed consistent pain at L3-4, L4-5, and L5-S1; the latter 2 discs had severe pain and loss of disc height (degeneration).  A neurosurgery examination on 4 April 2006, 5 months prior to separation, noted a normal neurological examination with painful motion and spasm of the paralumbar muscles.  Three weeks later, the CI reported radiation of pain to both lower extremities.  On examination, the thoracolumbar range-of-motion (ROM) was full and pain free.  Motion of the lumbosacral spine was painful and spasm was present.  The neurological examination remained normal.  Electrodiagnostic studies on 25 May 2006 were indicative of a left lumbar radiculopathy, but the exact level was indeterminate.  During the narrative summary (NARSUM) performed 14 July 2006, 2 months prior to separation, the CI reported his LBP began 2 years earlier after a long car drive.  The neurological examination was normal and tenderness was present in the paraspinal muscles without recorded spasm.  The ROM was limited and painful as charted below.

At the VA Compensation and Pension (C&P) examination performed on 10 January 2007, 5 months after separation, the CI reported aggravation of his back pain from lifting helicopter parts as well as a hard landing.  His gait and posture were normal on examination.  He was able to walk on his toes and his reflexes were normal.  An MRI showed a herniated disc at L4-5 with impingement of the tissue lining the spinal cord (thecal sac), but impingement of the cord or nerve roots was not recorded.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition at 10%, coded 5299-5242 (degenerative arthritis of the spine).  The VA rated the back at 20%, coded 5243 (intervertebral disc syndrome).  The loss of motion on both the MEB and C&P examinations supports a 20% rating.  The VA subsequently added a radiculopathy of the left and right lower extremities, but effective 23 April 2013, almost 7 years after separation and based on post-separation progression.  The Board agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees) as reported on the MEB and VA examinations proximate to separation.  The Board considered whether a higher rating (§4.7) was achieved by using the alternate rating formula based on incapacitating episodes due to intervertebral disc syndrome.  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 (reasonable doubt), the Board recommends a disability rating of 20% for the back condition.

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.  There were no other conditions within the Board’s scope of review for consideration.  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%	
RATING	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131220, 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, AR20160005830 (PD201400436)

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