RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00711
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040304

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Air National Guard or National Guard E4, Food Service Specialist, medically separated for “chronic back pain” with a disability rating of 10%.  

CI CONTENTION:  “Radiculopathy, herniated disc, right leg paresthesia and degenerative disc disease.”  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 based upon a 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 20030812	VARD - 20040702	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5299-5237	10%	Chronic Low Back Pain Secondary to Lumbar Muscle
Strain	5237	NSC	20040225	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Back Pain Condition.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic back pain condition began in November 2002 while deployed.  The CI reported low back pain (LBP) and radiation to both lower extremities (LEs).  Lumbar X-rays showed mild degenerative joint disease.  She was evaluated by orthopedics and the diagnosis was LBP and medical evacuation for a PEB was recommended.  An MRI was performed and read by radiology as negative.  Neurosurgery did not recommend any surgery and diagnosed the back condition as muscle strain, possible L4-5 disc bulge.  The neurosurgical consult recommended against a MEB.  The MEB forwarded “chronic low back pain secondary to lumbar muscle strain and L4-5 bulging disc with radiculopathy” and also noted “numbness and tingling left lower extremity” for PEB adjudication.  

During the MEB examination (recorded on DD Forms 2807 and 2808) on 5 June 2003, 9 months before separation, the CI reported LBP pain with numbness and swelling of the left leg and toe.  The physical examination showed tenderness to palpation (TTP) of the right buttock and flexion of 35 degrees (normal 90).  There was decreased sensation of the inner aspect of the right lower extremity (LE) noted.  Straight leg raise testing to elicit radicular signs was negative.

The MEB NARSUM examination on 1 July 2003, 8 months before separation, noted complaints of LBP with occasional shooting pain into the posterior left thigh, with left LE numbness.  The physical examination described back ROM as flexion “decreased 50%.”  There was TTP and muscle tightness with abnormal contour of the lumbar spine.  There was no muscle atrophy, LE reflexes were symmetric bilaterally and sensation was decreased on the inner aspect of the right LE to the ankle.  

At the VA Compensation and Pension (C&P) examination performed on 10 January 2004, 2 months before separation, the CI reported LBP with LLE radiculopathy.  The physical examination showed forward flexion of 70 degrees with combined ROM of 200 degrees (normal 240 degrees), with painful ROM.  There was TTP of the lumbar spine without muscle spasm.  There was symmetric strength and reflexes throughout, and the CI reported a burning sensation on the back of the left thigh with SLR.  The examiner indicated lumbar spine X-rays, which were performed the same day and were negative. 

At a VA C&P spine examination was performed on 24 February 2004 1 week before separation, the CI reported LBP and left LE pain, without bowel or bladder problems.  Trigger point injections had provided temporary relief.  The physical exam noted forward flexion of 70 degrees, with poor effort and early giving way.  The VA examiner indicated the CI showed hypersensitivity and overreaction to left sided palpation.  There was no muscle spasm and seated SLR caused posterior thigh pain bilaterally, which the examiner indicated as negative.  Lower extremity strength and reflexes were normal.  The examiner commented that “I find no evidence of true weakness and/or limitation of motion aside from voluntary motor.”  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5299-5237 (analogous to lumbosacral strain), citing ROM limited by pain.  The VA initially did not service connect the low back condition.  However, the Decision Review Officer Decision (DROD) dated 4 April 2004, service connected the low back condition, and rated it 20%, effective the day after the date of separation based on VA outpatient treatment reports subsequent to the C&P exams summarized above.  

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 MEB DD Form 2808 and MEB NARSUM examinations and muscle tightness and tenderness with an abnormal spinal contour noted at the MEB NARSUM exam.  Although the VA C&P exams noted forward flexion of 70 degrees, the VA later also assigned a 20% rating based on limitation of motion noted at outpatient VA treatment visits.  The Board concluded that based on the totality of evidence in record the 20% rating most nearly approximated the CI’s disability due to the low back condition.  A 40% rating was not supported at separation for “TL forward flexion limited to 30 degrees or less and there was no documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes which would provide for a higher rating under that formula (for IVDS).  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 low back condition.  

The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  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.  While the CI reported radiating pain at times to both lower extremities and at others only to the left lower extremity, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  Therefore the critical decision is whether or not there was a significant motor weakness which would impact military occupation-specific activities.  There was no evidence LE that motor weakness existed to any degree that could be described as functionally impairing.  Decreased right lower extremity sensation was noted at the MEB DD Form 2808 and MEB NASRUM exams, however, not in a distribution anatomically consistent with a single nerve root and decreased sensation was not addressed at either C&P exam, but normal strength and reflexes were noted.  The Board therefore concluded that an additional disability rating was not justified on this basis.  

BOARD FINDINGS:  In the matter of the chronic low back pain condition, the Board unanimously recommends a disability rating of 20%, coded 5299-5237 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 her prior medical separation:  

CONDITION	VASRD CODE	RATING	
Chronic Low Back Pain	5299-5237	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131003, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

	
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 AR20160014386 (PD201400711)

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