RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01274
BRANCH OF SERVICE:  Army 		SEPARATION DATE:  20080819

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Signal Support Systems Specialist, medically separated for a lower back pain condition, rated at 10%.  

CI CONTENTION:  The CI contends that his back condition should have been rated higher, and that he should have received ratings for PTSD (post-traumatic stress disorder), tinnitus, and TBI (traumatic brain injury).  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 - 20080502	VARD - 20080917	
Condition	Code	Rating	Condition	Code	Rating	Exam	
L4-5 Herniated Disc …	5243	10%	Lumbar Strain…	5237	10%	20080722	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:    

L4-5 Herniated Disc without Motor Neurologic Deficits Condition.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had chronic intermittent low back pain that was exacerbated in the summer of 2006 when he was moving heavy items while deployed.  Radiographic studies performed in May and June 2007 showed normal vertebral bone structure, but a single disc bulge in the lower spine with narrowed space in a nerve cavity, which the examiner said indicated “questionable encroachment upon the left L4 nerve root.”  The spinal discs were all intact and there was no narrowing of the spinal canal itself.  Evaluation by a physical medicine and rehabilitation physician on 20 February 2008 noted complaint of chronic low back pain with left lower extremity numbness and tingling.  The CI denied disturbance of bowel or bladder function.  On physical examination there was no motor dysfunction (normal strength, coordination), with normal reflexes, sensation and gait.  Electrodiagnostic study (EMG/NCV) performed 20 February 2008, showed abnormalities in the left tibialis anterior muscle suggestive of a chronic L4-5 radiculopathy however other L4-5 innervated muscles did not show abnormalities to suggest radiculopathy and the examiner concluded the isolated findings in the tibialis anterior muscle could be non-specific.  There was no surgical indication and the CI was treated with physical therapy, duty restriction, and medication.  Despite treatment, the CI’s back condition could not be adequately rehabilitated to meet the physical requirements of his military specialty, so he was referred for an MEB.  

The MEB NARSUM examination on 10 January 2008 (7 months prior to separation) noted complaints of chronic back pain for approximately 20 years.  The CI reported tingling but denied weakness or numbness in his left lower extremity, and also denied any bowel or bladder incontinence.  He reported back pain rated at 7/10 (with 10 being the worst), and indicated the ability to walk but inability to run or to perform repetitive bending or significant lifting.  Physical examination showed tenderness of the muscles on either side of the lower spine.  The gait was normal.  Strength, reflexes, and sensation were all normal.  Testing for irritated sciatic nerves were negative (the sciatic nerve is the long nerve running from the base of the back, down each leg and into the foot).  At the VA Compensation and Pension (C&P) examination on 22 July 2008 (a month before separation), the CI reported back pain which he indicated had existed for 2 years.  He also reported symptoms of stiffness, numbness, and bowel and bladder incontinence that he attributed to his spinal condition.  The CI reported that he suffered from “leakage of urine and stool from September to November of 2007,” but that it was no longer a problem.  He reported pain at 7/10 (with 10 being the worst), brought on by physical activity and relieved with medication.  The CI reported sharp, intermittent stinging and numbness in his left leg, but denied incapacitation.  Physical exam revealed no evidence of radiating pain on movement and no stiffness or rigidity of the spine.  There was tenderness but no muscle spasm, and posture, spinal contour and gait were normal.  Repetition did not limit ROM.  There were “no signs of intervertebral disc syndrome with chronic and permanent nerve root involvement.”

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 5243 code (intervertebral disc syndrome), citing limited forward flexion and combined ROM with tingling but no numbness or weakness (as reported in the MEB PT and NARSUM exams).  The VA also assigned a 10% rating but used the 5237 code (lumbosacral strain), based on the VA C&P examination citing range of motion (which was normal) with no altered gait or contour.  The Board agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) and/or combined ROM (greater than 120 degrees but not greater than 235 degrees) as reported on the MEB physical therapy and VA C&P examinations proximate to separation.  The physical therapy examination performed 4 January 2008 showed forward flexion of 60 degrees, which could support a rating of 20%; however the examination was performed with an inclinometer rather than the required goniometer method, and was not consistent with the two examinations which were more proximate to separation.  Therefore the Board placed greater probative value on the MEB physical therapy examination and VA examination more proximate to separation.  There was no muscle spasm or guarding severe enough to result in abnormal gait or spinal contour, thus the next higher 20% rating was not justified on that basis.  There was no evidence of incapacitating episodes requiring bed rest prescribed by a physician to warrant consideration of rating under the alternate VASRD formula based on incapacitating episodes due to intervertebral disc syndrome.  The Board also considered whether additional disability rating might be justified for peripheral nerve impairment due to radiculopathy.  Radiographic and electrodiagnostic studies supported some level of radicular nerve irritation or involvement, but physical exams (physical medicine, physical therapy, MEB NARSUM, and VA C&P) proximate to separation revealed no objective findings of radiculopathy that would impact duty performance.  The report of bowel and bladder incontinence provided by the CI at the VA C&P examination was not corroborated or evidenced in any other exam and was specifically denied by the CI.  There was no evidence of an anatomic basis on magnetic resonance imaging for complaints of bowel or bladder function disturbance.  There is no evidence in this case that motor weakness existed to any degree that could be described as functionally impairing.  Instead, functional impairment was attributed to the back pain.  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 L4-5 herniated disc without motor neurologic deficits condition.

BOARD FINDINGS:  In the matter of the L4-5 herniated disc without motor neurologic deficits 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 no re-characterization of separation or modification of the disability rating previously assigned.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140305, 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 XXXXXXXXXXXXXXXXXXXXXXX AR20160005879 (PD201401274)

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
( ) OVA