RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00837
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080220

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5 (Water Treatment Specialist) medically separated by the Informal Physical Evaluation Board for a lumbar strain with a disability rating of 10%.  

CI CONTENTION:  His back condition continues to worsen and negatively impact his daily activities.  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 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:  

PDA ADMIN CORRECTED - 20090225	VARD - 20080506	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbosacral Strain	5237	10%	DDD Lumbar Spine with Radiculopathy	5242-5237	10%	20080325	
RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Lumbosacral Strain Condition.  According to service treatment records and the MEB narrative summary (NARSUM), the CI’s back condition began in February 2006 after moving sandbags while deployed.  Magnetic Resonance Imaging (MRI) of the lower spine showed an L4-L5 and L5-S1 posterior disc bulging, but there was no surgical indication.  Treatment did not result in sufficient improvement to allow return to unrestricted duties.  A clinical exam on 28 June 2007 (8 months prior to separation) noted the presence of lumbosacral muscle spasm and abnormal lumbosacral spinal contour. Slow movements due to pain were also noted.  A follow-up in a primary care clinic on 2 October 2007 (5 months prior to separation) noted muscle spasm and an antalgic gait although 2 days later a normal gait was observed. 

An MEB orthopedic consultation on 6 November 2007 (3 months prior to separation) noted no radicular symptoms into the leg.  Pain required the CI to change positions if seated for longer than 30-60 minutes.  Pain was much worse when standing, which he could only tolerate for 5-10 minutes.  Exam showed a normal gait and easy movement to the exam table.  Tenderness and scoliosis were not present, and muscle spasm was not mentioned.  Painful motion during extension reproduced his pain.  Lower extremity strength and reflexes were normal.
  
At the MEB narrative summary (NARSUM) examination on 19 December 2007 (2 months prior to separation) the CI reported he was unable to stand for long periods of time, or perform lifting or carrying required of his MOS.  He complained of constant low back pain that was occasionally associated with numbness in the right buttock.  Examination showed normal lumbar lordosis without mention of other spinal contour observations. Tenderness was present, but the exam was silent regarding gait or muscle spasm.   Thoracolumbar flexion was 90 degrees (normal 90 degrees) and combined range-of-motion (ROM) was 230 degrees (normal 240 degrees).  Painful motion was present in extension.  Lower extremity strength and reflexes were normal.

At the VA Compensation and Pension (C&P) examination on 25 March 2008 (a month after separation) the CI reported constant lower back pain that radiated to the right buttock.  Flares of pain occurred 3-4 times per week and lasted for a day.  There were no incapacitating episodes since his return from deployment.  Examination showed normal gait.  There was no tenderness or muscle spasm.  Thoracolumbar flexion was 70 degrees “without pain” and combined ROM was 210 degrees.  Extension was the only parameter associated with painful motion.  There was no additional limitation with repetitive motion.  Neurologic examination found diminished pain sensation of the right lateral thigh; but muscle strength and reflexes were normal.  The examiner rendered a diagnosis of degenerative disc disease with radiculopathy to the right buttock.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 5237 code (lumbosacral strain), citing tenderness to palpation as the rating rationale.  The VA also assigned a 10% rating using an analogous 5237 code based on the VA C&P examination.  The Board agreed a 10% rating was justified for the presence of tenderness and painful motion, but also for combined ROM noted on the NARSUM exam (greater than 120 degrees but not greater than 235 degrees).  The VA exam also supported a 10% rating, but no higher, for flexion greater than 60 degrees but not greater than 85 degrees.  In considering other pathways to a higher rating, it was noted that muscle spasm associated with an abnormal spinal contour or gait was present 5 and 8 months prior to separation, although this finding was not noted on subsequent exams.  The Board concluded that this was not a sufficient basis for a 20% rating (i.e. for muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis).  

There was no evidence of intervertebral disc syndrome resulting in incapacitating episodes requiring bed rest prescribed by a physician during the year prior to separation to warrant consideration of rating under the alternate VASRD formula based on incapacitating episodes due to intervertebral disc syndrome.  The Board also deliberated if additional disability was justified for lower extremity 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.  Although the CI experienced radiating numbness or pain to the right buttock, there was no objective evidence of functional impairment with a direct impact on fitness, such as muscle weakness.  The radiating pain component 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 concludes 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 concluded that there was insufficient cause to recommend a change in the PEB adjudication for the lumbosacral strain condition.

BOARD FINDINGS:  In the matter of the lumbosacral strain 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 20140219, 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 XXXXXXXXXXXXXXXXXXXXXXX, AR20160002398 (PD201400837)

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