RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-00452
BRANCH OF SERVICE:  Army	BOARD DATE:  20150211
Separation Date:  20060809

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Signal Support Systems Specialist) medically separated for low back pain (LBP).  The LBP could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The LBP condition, characterized as “chronic LBP,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “chronic back pain, without significant neurologic abnormality” as unfitting, rated 0% with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Hypertension was only considered in this review.  Per my medical records I was discharged because of my back issues.  I now have to pay for recurring issues regarding severe problems and request a review.  My separation was due to severe back issues.  A review of my medical records will show this.  My injury has followed my career in the Army throughout!  I asked for a transfer several times and was denied by my chain of command.  I would have chosen to stay in the military and continued my service.  I was deemed, unfit!  Now, I have to deal with back pain, hypertension on a daily basis!!”

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:

Service IPEB – Dated 20060712	VA - (No Show)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP	5299-5237	0%	Chronic LBP (Claimed as Herniated Nucleus Pulpous/Sciatic Radiculopathy/Osteoarthritis/
Degenerative Disc Disease [DDD])	5243-5242	Not Service Connected	No Show	
Other x0	Other x1	
Combined:  0%	Combined:  10%	
Derived from VA Rating Decision (VARD) dated 20070924 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Chronic LBP Condition.  The CI developed LBP in November 2004 when he fell while carrying a heavy load during Basic Training.  He developed some muscle spasm and after a few days of pain, went to sick call.  The lumbar spine X-ray showed mild osteoarthritis and DDD L5-S1.  The CI was seen for LBP in Medical Clinic with physical exam findings of tenderness to palpation (TTP) in the bilateral paraspinal areas and decreased range-of-motion (ROM).  The physical therapist noted sharp LBP for 2 weeks, aggravated by running and push-ups.  The physical exam findings were forward flexion limited to hands only reaching mid-thigh with normal motor and sensory exams.  The CI was seen in sick call for LBP.  A lumbar spine magnetic resonance imaging was performed for LBP and numbness that radiated into both legs.  The imaging showed a small to moderate sized right paracentral disc herniation at L4-5 causing mild to moderate central canal stenosis, moderate right foramina right L4 nerve root encroachment/stenosis, and advanced degenerative disc changes with broad based disc bulging L5-S1.  The CI was fitted with a back brace for LBP.  He was referred to a Chiropractor for back manipulations and was noted to have TTP in both the right and left paraspinal areas.  A lumbar spine X-ray showed mild disc narrowing at L3-4, L4-5 and L5-S1 levels along with mild sclerosis and osteophyte formation of L4-5 consistent with mild degenerative changes.  The CI was evaluated by Physical Rehabilitation Medicine which recommended epidural steroid injections.  The CI showed slight improvement for a few days, but then regressed with sciatic radiculopathy.  The CI had a slip and fall on 21 June 2005 and the emergency room (ER) examiner noted back pain and leg pain.  A lumbar spine X-ray performed in the ER showed disc narrowing at L5-S1, mild posterior osteophytes at L5 and mild anterior osteophytes at L4.  The CI underwent a medial spinal blocking in November 2005.  The spinal surgeon documented that a discussion centered on different possible surgical options.  The CI underwent a second medial branch block.  The spine surgeon noted that because of the multilevel involvement, surgery would not be a viable options and he recommended conservative treatment.  The MEB narrative summary exam performed approximately 5 months prior to separation documented that the CI had chronic daily pain.  The examiner also noted that the CI admitted to a number of Waddell symptoms which included positive tailbone pain, whole leg numbness, whole leg pain, and posterior give way of left leg.  The MEB physical exam findings were essentially normal ROM measurements with exception of extension which was 20 degrees (30 degrees normal) for a combined of 230 degrees.  He had painful motion, no TTP and normal gait, strength, sensory exams.  There was no evidence of radicular signs or symptoms.  The CI failed to show for his scheduled VA Compensation and Pension (C&P) exam on 27 June 2007.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the chronic LBP condition as 5299 analogous to 5237 (lumbosacral or cervical strain) and rated at 0%.  The VA coded the chronic LBP condition as 5243, (Intervertebral Disc Syndrome), with 5242 (degenerative arthritis of the spine) and did not grant service-connection due to failure to show for the C&P exam.  The General Rating Formula for Diseases and Injuries of the Spine considers the CI’s pain symptoms “with or without symptoms such as pain (whether or not it radiates), stiffness or aching in the area of the spine affected by residuals of injury or disease.”  The CI met the 10% rating criteria of “combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees.”  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the chronic LBP 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 chronic LBP condition, the Board unanimously recommends a disability rating of 10%, coded 5242 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:

UNFITTING CONDITION	VASRD CODE	RATING	
Chronic Low Back Pain	5242	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140114, 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 XXXXXXXXXXXXXXX, AR20150010999 (PD201400452)

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 10% 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:

Encl		     

CF: 
(  ) DoD PDBR
(  ) DVA