RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX  	CASE:  PD-2014-00619
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060915

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Infantryman, medically separated for “chronic back pain due to lumbar degenerative disc disease with neurologic abnormality,” with a disability rating of 10%.

CI CONTENTION:  “…I suffer from lower spinal pain every day.  It is difficult to stand for long periods of lime, and it is uncomfortable to lift objects of average weight.  Some days I am restricted to sitting because the nerves get pinched near the base of the spine making it difficult for me to flex or turn.  On some occasions a slight wrong movement of my right leg aggravates the sciatic nerve rendering me motionless for a few hours.  A spinal injury is not something that will cure itself over time, it is permanent.”  The CI’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 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 - 20070117	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain due to Degenerative Disc Disease without Neurologic Abnormality	5299-5242	10%	Degenerative Disc Disease Lumbar Spine	5243	20%	20061124	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Back Pain due to Degenerative Disc Disease.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s condition began in June 2002 after a parachute malfunction caused an early canopy release and he fell from a tree top to level ground.  He was taken off jump status and had intermittent back problems until October 2005, when his symptoms worsened.  A neurological examination by neurology documented that muscle bulk, muscle tone, strength, sensation, and deep tendon reflexes (DTRs) were normal and clonus (rhythmic muscular spasm) was absent.  A radiographic (X-ray) study done in October 2005 was normal, however a magnetic resonance imaging (MRI) study done in January 2006 showed a small broad-based central disc protrusion at L4-5 with bilateral recess narrowing without significant canal narrowing.  An electrodiagnostic study suggested a mild L5 (R>L) nerve root irritation, but was otherwise within the range of normal variation.  Over serial orthopedic surgery encounters, the CI complained of radicular (nerve root irritation or injury) pain down the posterior right or bilateral lower extremities.  Serial exams documented a normal gait and negative straight leg raise (SLR) tests (assess for herniated disc causing sciatic nerve root [L5-S1] radiculopathy with the leg between 30 and 70 degrees).  Strength, sensation, and DTRs were normal.  Despite treatment, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  At the MEB examination recorded on DD Form 2808 dated 6 July 2006, approximately 2 months prior to separation, the examiner recorded hip flexor muscles with 4/5 weakness secondary to pain.  The examiner also noted that the CI was able to walk on his toes and heels.  The NARSUM examination dated 13 July 2006, approximately 2 months prior to separation noted that the CI reported dull constant achy back pain with occasional radiation into his right leg rated at rest at 5/10 which caused him to adjust his position after a few minutes.  He also reported that the pain would increase to 9/10 with going up and down stairs and taking his infant daughter out of her car seat.  The physical examination documented a normal gait, negative SLR tests, and normal DTRs.  There was normal 5/5 strength, except for 4+/5 hip flexors secondary to pain.  Examination findings are summarized in the chart below.  At the general VA Compensation and Pension (C&P) examination in November 2006, performed approximately 2 months after separation, the CI reported constant back pain both sharp and dull at times rated at 8-9/10 depending on the activity with an occasional shooting pain that radiated into both legs.  He had functional impairments of an inability to lift greater than 45 pounds and walk greater than 4 hours daily.  The CI had been unemployed since discharge from active duty.  The physical examination documented that gait, muscle bulk, muscle tone, strength, sensation, and DTRs were normal.  Examination findings are summarized in the chart below.  The brain and spinal cord C&P examination by neurology documented no complaints of radiculopathy.  The physical examination documented a normal gait and positive (right 45 and left 50 degrees) SLR tests.  Strength and DTRs were normal and pathologic reflexes were absent.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5242 code (degenerative arthritis of the spine), citing painful motion and limitation of motion by pain with localized tenderness.  The VA assigned a 20% rating using the 5243 code (intervertebral disc syndrome) based on the VA C&P examination 2 months after separation, citing muscle spasms and lumbar scoliosis.  The ROM values in the proximate exams (MEB and C&P) were consistent with the 10% rating (flexion of greater than 60 degrees but not greater than 85 degrees; or a combined ROM of greater than 120 degrees but not greater than 235 degrees of the thoracolumbar spine).  The higher 20% rating would require (flexion of greater than 30 degrees but not greater than 60 degrees; or a combined ROM of not greater than 120 degrees of the thoracolumbar spine).  The Board agreed a 10% rating was justified for the presence of painful motion and tenderness.  There was no evidence of muscle spasm or guarding on the MEB examination and although the VA C&P examination noted occasional muscle spasm the gait was normal, thus the next higher 20% rating was not justified on this basis.  While the CI complained of occasional lower extremity radicular symptoms, there was no evidence that motor weakness or sensory impairment 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.  There was no evidence of intervertebral disc syndrome resulting in 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 concluded that there was insufficient cause to recommend a change in the PEB adjudication for the chronic back pain condition.  

BOARD FINDINGS:  In the matter of the low back 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.  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 20140122, 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, AR20160006640 (PD201400619)

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