RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00511
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070615

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Health Care Specialist) medically separated for a back condition.  The back condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty (MOS).  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  “Chronic low back pain w/right sacroiliitis and right leg radiculopathy” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic low back pain…” as unfitting, rated 10%.  The CI made no appeals and was medically separated.  

CI CONTENTION:  She was not evaluated for her right shoulder, mental health and abdominal conditions.  Her 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/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:  

IPEB - Dated 20070426	VA* - (~4 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain…	5237	10%	Degenerative Disc Disease, Lumbar Spine, with Sacroiliitis and Right Radiculopathy	5242	10%	20071025 	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 12	
RATING:  10%	COMBINED RATING:  60%	
*Derived from VA Rating Decision (VARD) dated 20080222 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:

Low Back Condition.  The CI’s low back pain began in January 2004 after slipping on ice while pulling a heavy object.  The pain radiated to the right hip and right leg.  Radiographic imaging studies later showed minimal disc bulging at L4-5 and L5-S1, but surgery was not indicated.

At a pain clinic evaluation on 15 March 2007 (3 months prior to separation) the CI reported low back pain that radiated to the right hip and right lower extremity that did not extend below the knee.  Examination suggested the presence of some right sacroiliitis which appeared to temporarily improve symptomatically after an injection.  At the MEB exam on 28 March 2007 the CI complained of some numbness and tingling in her right leg for the last 4 months but denied impaired use of her leg.  The physical exam reported normal neurologic findings.  Electrodiagnostic studies on 2 April 2007 of the right lower extremity showed no evidence of radiculopathy.  Physical exam showed normal muscle strength.

The narrative summary (NARSUM) on 6 April 2007 recorded a chief complaint of low back pain and right hip inflammation that radiated down the right leg.  No other right lower extremity symptoms were mentioned.  The examiner rendered a diagnosis of chronic low back pain with right sacroiliitis and right leg radiculopathy.

At the VA Compensation and Pension (C&P) exam performed 4 months after separation, the CI reported that during the previous 12 months she experienced 4-5 “incapacitating episodes with doctor note” lasting 3-4 days each.  Physician-prescribed bed rest was not mentioned.  The examiner did not have the service treatment record (STR) available for review. The CI also reported radiation of back pain to both legs associated with a tingling sensation of the entire right lower extremity with numbness.  The back condition did not pose an impediment to her current occupation working in a clinic.  Examination showed normal neurologic findings, including muscle strength of the lower extremities.

The goniometric range-of-motion (ROM) evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Thoracolumbar ROM
(Degrees)	MEB ~2 Mos. Pre-Sep	VA C&P ~4 Mos. Post-Sep	
Flexion (90 Normal)	90 (90, 85, 90)	90	
Combined (240)	215	240	
Comment	+spasm, tenderness; normal gait, contour	+tenderness, painful motion; normal gait and curvature. No ROM change after repetition	
§4.71a Rating	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10%, coded 5237 (lumbar strain), while the VA also assigned a 10% rating using the 5242 code (degenerative arthritis of the spine).  The Board agreed that a 10% rating, but no higher, was justified for combined ROM greater than 120 degrees but not greater than 235 degrees reported on the MEB exam.  The presence of tenderness or muscle spasm without associated gait or spinal contour abnormality also warranted a 10% rating.  The Board also considered rating intervertebral disc disease under the alternative formula for incapacitating episodes.  The Board agreed that right sacroiliitis, although not specified by the PEB, was properly subsumed under the low back pain condition.  Although the CI reported “incapacitating episodes” totaling approximately 20 days during the preceding year, there was no evidence in the STR of physician-prescribed bed rest sufficient to support a higher rating under the formula for rating intervertebral disc syndrome.
The Board finally considered if additional disability was justified for right lower extremity radiculopathy.  The CI experienced intermittent right lower extremity radiating pain and numbness.  However, electrodiagnostic studies were negative for radiculopathy and examinations recorded normal muscle strength.  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 experienced some 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 therefore concluded that this condition could not be recommended for additional disability rating.  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 intervertebral disc syndrome 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 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.  

RECOMMENDATION:  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 20140102, 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 XXXXXXXXXXXXXXXXXXXXXX, AR20160000245 (PD201400511)

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