RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00609
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050104

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Army Reservist, O3, Military Intelligence Officer, medically separated for “chronic low back pain,” rated at 10%.  

CI CONTENTION:  The CI contends the full scope of his back injury was not considered and he elaborates the severity of his condition. 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 Physical Evaluation Board (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 - 20041007	VARD - 20050304	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Degenerative Disc Disease Thoracolumbar Spine	5242	20%	20041130	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in early 1999 while attending the Officer Basic course.  A pre-service hospital note dated 6 June 1993 showing the CI was diagnosed with mild lumbar and thoracic strain following a motor vehicle accident.  Magnetic resonance imaging (MRI) studies in April 2004 showed L5-S1 degenerative disc disease, a transitional S1 vertebral body, L1-L2 central disc protrusion and L5-S1 posterior subannular disruption versus fissure (degenerative disc disease).  There was no significant foraminal narrowing or central canal stenosis.  There was no herniated nucleus pulposus (HNP) or compressive discopathy.  
He was evaluated by neurosurgery on 12 May 2004 (6 months prior to separation), complaining of chronic back pain in his right lower paralumbar region with no improvement in 2 years.  He reported his pain was worse with almost all activities, especially when bending and lifting.  He was evaluated and treated at physical therapy and at the pain clinic prior to being seen by Neurology with no improvement.  He did not report any radicular symptoms.  The examiner documented that strength was 5/5 in lower extremities bilaterally.  He had bilateral lower extremity reflexes of 2+ his bilateral straight leg raise (SLR; for radicular signs and symptoms) was negative.  There was no dysfunction in his gait or coordination.  There was no surgical indication.  The examiner noted that the CI was undergoing a retention board and recommended that he continue with conservative, non-operative therapy.  

Despite treatment, the CI’s back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and was referred for an MEB.  

The MEB NARSUM examination on 3 June 2006 (6 months prior to separation) noted complaints of sharp back pain that became worse with aggravation.  He reported pain with muscle spasm at 3/10 but when aggravated it is 6-7/10.  Precipitating factors were lifting, prolonged standing, marching and walking on uneven ground.  He reported worsening since 2002 and was seen and treated by physical therapy, chiropractic, neurosurgery and the pain clinic.  He had two epidural injections that both provided approximately 2 weeks of relief each time.  Physical exam showed pain and tenderness to palpation and full ROM with increased pain with backward and right side bending.  He had 5/5 strength in his lower extremities bilaterally.  There was a negative SLR and a normal gait.  

At the VA Compensation and Pension (C&P) examination on 30 November 2004, performed approximately a month before separation, the CI reported he had injured his back during a parachute accident.  He reported his pain to be 2-3/10 but said it is 6-7/10 when aggravated.  He was taking narcotic medication (Vicodin, Hydrocodone and Oxycontin) for severe pain.  He reported his pain as located in the lower back and very sharp.  It was exacerbated by cycling, swimming and running.  He stated he had no bowel, bladder or erectile dysfunction.  He reported that he could walk 2-3 miles but that he had zero recreational activities.  Physical examination showed limited ROM with pain (see chart).  His pain increased significantly after three repetitions.  He demonstrated poor heel-toe walking.  His major functional impacts were pain, weakness, fatigue and endurance.  Examination tests for radicular signs were negative, and neurologic exam documented no deficits.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back pain condition 10% coded 5237 (lumbosacral strain), citing painful motion.  The VA rated the back pain condition 20% coded 5242 (degenerative arthritis of the spine), based on the VA C&P examination, citing limitation of forward flexion.  

In assigning probative value to these somewhat conflicting examinations, the Board noted that the VA pre-separation examination was comprehensive and closest to the date of separation.  Therefore, the Board agreed that preponderant probative value should be assigned to the VA examination.  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) reported on the pre-separation VA examination.  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.  The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI had no radiculopathy and the Board 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 back pain condition, coded 5242.  

BOARD FINDINGS:  In the matter of the 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, therefore, recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Low Back Pain	5242	20%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140126, 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, AR20160005579 (PD201400609)

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