RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX		CASE:  PD-2014-01212
BRANCH OF SERVICE:  Army		SEPARATION DATE:  20070520

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E-5, Cavalry Scout, medically separated for “chronic low back pain” with a disability rating of 0%.

CI CONTENTION:  His condition was much worse at separation than how it was rated and his condition continues to impact his ability to function.  His 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 - 20070306	VARD - 20070530	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain 	5237	0%	DDD at L5-S1	5243	0%	20070530	
COMBINED RATING:  0%	COMBINED RATING FOR ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Chronic Low Back Pain (Leg pain).  The record shows that the CI developed low back pain (LBP), with radiation down the right lower extremity (RLE) to the foot, in December 2004 following a parachute landing.  The first record in evidence is a magnetic resonance imaging (MRI) report dated 22 January 2005 which noted a herniated disc at L5S1 with impingement of the right S1 nerve root as well as degenerative disc disease (DDD) at L3-4 and L4-5.  He was treated with a series of steroid injections [ESI] with improvement in his symptoms.  On 14 April 2005, he was noted to have full range of motion (ROM) and normal strength.  He was seen periodically over the next few months treated with medications, duty limitations, and chiropractic manipulation.  At a physical medicine and rehabilitation (PMR) visit on 15 December 2005, he was noted to have painful motion, but a normal neurological examination.  These remained stable findings on the next several examinations.  An orthopedic examination on 11 May 2006, just over 12 months prior to separation, noted sensory and motor loss of the RLE with atrophy of the right calf muscle.  He was thought to be refractory to treatment.  At the Medical Evaluation Board (MEB) narrative summary (NARSUM) examination dated 05 December 2006, approximately 6 months before separation, the CI reported bad back pain.  It was noted that a repeat MRI on 11 May 2006 had been essentially unchanged from the initial MRI in January 2005.  A neurosurgical evaluation had recommended continued non-surgical treatment.  On examination, he had a normal gait.  Provocative testing for nerve root irritation was positive on the right.  Weakness and sensory loss were present in the RLE.  The ROM was measured in physical therapy on 18 December 2005, approximately 5 months before separation, limited by pain.  It is charted below.

At the VA Compensation and Pension (C&P) examination dated 5 April 2007, approximately 6 weeks before separation, the CI reported pain radiating down both legs and 5 days of incapacitation the prior 12 months.  On examination, he had a normal posture and gait and used no assistive device.  Muscle spasm and tenderness were absent.  Provocative testing for nerve root irritation was negative.  The ROM was normal and not limited with repetition.  Painful motion was not documented.  The CI was seen by VA primary care on 9 July 2007, approximately 8 weeks after separation, to establish care.  The examination was limited, but he was noted to have paralumbar tenderness.  The CI was seen by VA PMR on 9 August 2007, approximately 3 months after separation.  The gait was normal and the ROM full, but painful at the extremes of motion.  Paralumbar tenderness was present.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the back at 0%, coded 5237 (lumbosacral strain) and 5243 (intervertebral disc syndrome), respectively.  The ROM measurements which were done in physical therapy for the MEB support a 40% rating.  These are not consistent with other normal measurements recorded in the record or two VA examinations more proximate to separation.  Tenderness is recorded on two post-separation examinations both of which were within a few months of separation.  These support a 10% rating.  The neurological examination proximate to separation was normal.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the back condition, coded 5237.

BOARD FINDINGS:  In the matter of the chronic back pain condition, the Board unanimously recommends a disability rating of 10%, coded 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 his prior medical separation:

CONDITION	VASRD CODE	RATING	
Chronic Low Back Pain	5237	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140304, 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 XXXXXXXXXXXXXXXXXXXX, AR20160006042 (PD201401212)

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 10%
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