RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00949
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20020718

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Light-Wheeled Vehicle Mechanic, medically separated for “mechanical low back pain” with a disability rating of 10%.

CI CONTENTION:  The CI made no specific contention in their application.  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 - 20020403	VARD - 20030102	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Mechanical Low Back Pain	5299-5295	10%	Degenerative Changes, Lumbar Spine	5292	10%	20021007	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Low Back.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI injured his back in a motor vehicle accident (MVA) approximately 2 years prior to referral for MEB.  A lumbosacral spine X-ray was normal.  A lumbar spine computerized tomography (CT) showed a congenital (inborn physical abnormality or disease) abnormality with six lumbar type vertebral bodies with a transitional vertebra at the lumbosacral junction (L6).  There was a pseudoarticulation (false joint or nonunion) of the right transverse process of L6 and bulging discs at L4-L5 and L5-S1 with spinal canal stenosis (narrowing).  A spine X-ray showed 5 degrees cervical spine scoliosis (abnormal lateral spine curvature) centered at C6 (right concavity) with a compensatory lumbar spine scoliosis.  Pain management performed three epidural steroid injections with local anesthetic and corticosteroid.  Pain management then performed a provocative discogram (increasing disc pressure with injected contrast to provoke characteristic pain) to rule out discogenic back disease with chronic low back pain and radiculopathy (irritation or injury of a nerve root).  Typical disc appearance was seen and there was no provocation of the CI’s usual back pain.  At the pain management follow-up, the CI complained of ongoing debilitating back pain.  Recognizing that the discogram was not provocative, and showed no evidence of a disc tear, the CI opted for a nucleoplasty (percutaneous disc decompression through catheter ablation of disc core material) procedure.  Pain management performed a left L5-L6 level nucleoplasty with serial ablation and coagulation of the disc nucleus.  At a neurosurgery consultation, the CI reported an 18-month history of left-sided low back pain without any specific precipitating mechanism.  He denied lower extremity pain or numbness and denied difficulty with bladder control.  The examiner recounted the history of profiles, physical therapy (PT), nucleoplasty, and medications as well as X-ray and CT findings.  The physical examination revealed no paraspinous spasm or distinct trigger points (tender loci which refer pain to another area).  Strength, sensation, and deep tendon reflexes (DTRs) were normal and pathologic reflexes were absent.  The assessment listed mechanical back pain and the neurosurgeon opined that surgical intervention would not be beneficial.  A PT examination documented a normal gait and negative straight leg raise (SLR) and slump tests (assess for herniated disc causing sciatic nerve root radiculopathy).  The lumbar active range-of-motion (ROM) was within normal limits.  Strength and DTRs were normal.  The assessment listed chronic mechanical back pain.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated December 2001, 7 months prior to separation, “spine, other musculoskeletal” was checked “normal.”  The NARSUM examination, 6 months before separation, recounted the history and interventions.  The CI complained of chronic, non-radiating, 7/10 low back pain since his MVA.  He denied weakness, numbness, and gastrointestinal or genitourinary difficulties.  The CI denied significant improvement from conservative management, epidural steroid injections, or nucleoplasty.  Pain was exacerbated by activity (sit-ups, push-ups, running, and lifting) and the active medication was acetaminophen (Percogesic).  The focused physical examination documented an undisturbed gait.  There were no spasms or trigger points.  The SLR tests were negative.  Strength, sensation, and DTRs were normal and pathologic reflexes were absent.  The examiner cited the medical examination for the MEB for the balance of the report.  The examiner recounted the X-ray and CT findings.  The VA Compensation and Pension (C&P) examination in October 2002, 3 months after separation, recounted the history and interventions.  The CI denied radiation and fecal or urinary incontinence.  Pain was exacerbated by prolonged sitting, bending, and lifting and the active medication was Motrin.  The physical examination documented normal ambulation and the ability to heel walk and toe walk.  The lumbosacral spine examination revealed muscular atrophy with no deformity or tenderness.  The SLR tests were negative and the DTRs were normal.  The lumbosacral spine active ROM was flexion of 80, extension of 30, left lateral flexion of 25, right lateral flexion of 20, and bilateral rotation of 25 degrees.  There was evidence of pain with repetitive (X10) ROM.  There was no evidence of fatigability, incoordination, or further loss in function following repetitive ROM.  The lumbosacral spine X-ray showed a transitional lumbosacral junction with a pseudarthrosis on the right with some degenerative changes.  The impression listed low back pain with decreased ROM.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5295 code (lumbosacral strain) citing chronic mechanical low back pain, no neurologic abnormality or chronic paravertebral muscle spasms on repeated exams, characteristic pain on motion.  The VA assigned a 10% rating under the 5292 code (limitation of motion of lumbar spine) based on the VA C&P exam 3 months after separation, citing lumbar spine degenerative changes by X-ray and slightly limited lumbar spine ROM.  In accordance with DoDI 6040.44, the Board is required to recommend a rating IAW the VASRD in effect at the time of separation.  The Board must correlate the above clinical data with the 2002 rating schedule; applicable diagnostic codes include: 5292 (limitation of lumbar spine motion); 5293 (intervertebral disc syndrome); and 5295 (lumbosacral strain).  Examinations proximate to separation did not show limitation of motion.  There was no evidence of intervertebral disc syndrome or incapacitating episodes requiring bedrest prescribed by a physician.  All members agreed a 10% rating was supported based on characteristic pain on motion under VASRD diagnostic code 5295 (lumbosacral strain).  There were no findings to support higher ratings under this code such as muscle spasm on forward bending.  At the time of the NARSUM, there was no radiating pain or objective findings to support consideration of a separately unfitting peripheral nerve 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 low back 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 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 XXXXXXXXXXXXXXXXXX, AR20160005816 (PD201400949)  

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