RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01049
BRANCH OF SERVICE:  Army	BOARD DATE:  20141219
SEPARATION DATE:  20080323

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6 (Artillery) medically separated for low back pain (LBP).  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The back condition, characterized as “chronic LBP with spondylosis and degenerative disc disease (DDD)” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded three other conditions meeting retention standards for PEB adjudication.  The Informal PEB adjudicated “chronic LBP from degenerative arthritis” as unfitting, rated 10%, referencing the VA Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to meet retention standards.  The CI made no appeals and was medically separated. 

CI CONTENTION:  “Even though I can work it hurts my back even more.  All doctors want to do is give me another surgery.  Well I am done with all that!”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  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/Naval 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 Admin IPEB – Dated 20080417	VA – At Separation  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5242	10%	Intervertebral Disc Syndrome L-Spine	5243	10%	20080311	
			Sciatica, Lt Leg assoc w/ Intervertebral Disc Syndrome	8720	10%	20080311	
Other x 3 (Not In Scope)	Other x 1	
Combined:  10%	Combined:  20%	
Derived from VA Rating Decision (VARD) dated 20080728 (most proximate to date of separation [DOS]).
ANALYSIS SUMMARY:  

Low Back Condition.  The CI first reported an insidious onset of LBP in June 2006 without direct impact injury or precipitant; and, the pain persisted throughout the balance of his military career.  X-rays were consistent with arthritic changes about the lumbosacral (LS) spine.  Initially, his LBP radiated to his upper back and he denied lower extremity involvement.  His treatment involved medication, manipulation and trigger point injections providing only temporary relief of pain.  Magnetic resonance image revealed a large lumbosacral disc extrusion compassing upon the left S1 nerve root.  Without any additional inciting event, the CI developed pain and numbness extending into his left buttock, leg, foot and toes in October 2007.  Multiple treatment modalities were pursued to include selective nerve blocks and epidural steroid injections, which provided temporary relief of leg symptoms all of which returned to pre-injection intensity.  On 13 March 2007, he underwent an L5-S1 discectomy with decompression of the S1 nerve root.  A month after surgery, having no relief of left leg symptoms, he was diagnosed with sciatic neuritis, placed on steroids, profiled accordingly and initiated a second round of nerve blocks and steroid injections.  Again, this round of treatment failed and he endorsed bilateral posterior paresthesia’s extending down to his feet.  On 21 September 2007, (6 months prior to separation) the CI obtained a second opinion endorsing both LBP and bilateral leg pain.  The physical examination (PE) was detailed and completely normal except for mild tenderness of the LS spine and painful motion.  MEB proceedings were initiated in September 2007.

At the narrative summary examination on 27 November 2007; 4 months prior to separation, the CI endorsed a constant sharp, stabbing, tingling pain to his low back with occasional symptoms down to his left knee.  Pain aggravators include running, prolonged walking/standing/sitting, riding in a car more than an hour and lifting heavy objects.  Pain relief is obtained with medications and avoiding the aggravating factors.  The PE revealed left-sided lumbar muscle spasm, tenderness and decreased sensation to the left posterior thigh.  All other exam parameters were normal.  The diagnosis was chronic LBP with DDD.  The commander’s statement noted the CI’s inability to perform his required MOS duties and the permanent profile listed LBP as the sole diagnosis.  There was no documentation of VASRD defined periods of incapacitation.  At the VA Compensation and Pension examination on 11 March 2008; 2 weeks prior to separation, the CI reported constant aching, sharp LBP described as morning stiffness, weakness, with feelings of intermittent “electric shocks.”  He further endorsed “the pain travels to all over back and down left leg.”  The examiner noted that at the time of pain he can function with medication.  His PE revealed tenderness to the lumbar spine and decreased sensation to the outside of his left ankle.  All other parameters of a detailed examination were normal.  The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below. 

DOS 20080323
Thoracolumbar ROM
(Degrees)	MEB ~4 Mo. Pre-Sep
(20071127) 	VA C&P ~ at-Sep
(20080311) 	
Flexion (90 Normal)	“Full ROM”	80	
Combined (240)	240	205	
Comment	spasm; tenderness;
minimal sensory deficit; normal gait	painful motion	
§4.71a Rating	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the back condition 5242 (degenerative arthritis) at 10% citing the presence of tenderness and spasms.  
The VA separately rated intervertebral disc syndrome (5243) and a sciatic peripheral nerve code at 10% each, for a combined total of 20%.  Board members first agreed that sufficient evidence of painful motion was present to justify the rating of 10% IAW VASRD §4.59, as well as the presence of localized tenderness not resulting in abnormal gait or spinal contour IAW §4.71a.  Members then considered and deliberated whether a separately ratable neuropathy existed with functional impairment linked to fitness near the time of separation.  Members concluded that despite having subjective complaints of a lower extremity neuropathy at the VA exam (at separation), the objective evidence of decreased sensation confined to an area of the ankle did not meet criteria for concluding it was a separately unfitting condition, and therefore, cannot be recommended for additional disability rating.  Additionally, any pain component of a radiculopathy is subsumed under the general spine rating as specified in §4.71a.  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 of the low back condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  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.

RECOMMENDATION:  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 20140227, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

				

SAMR-RB									

MEMORANDUM FOR Commander

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXX, AR20150008701 (PD201401049)

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:

Encl						
						         
CF: 
(  ) DoD PDBR
(  ) DVA