RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01374
BRANCH OF SERVICE:  Army	Seperation date:  20060516

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E3, Healthcare Specialist, medically separated for low back pain, rated at 0%.  

CI CONTENTION:  The CI contends continued pain from her condition and requests her rating be increased to allow disability retirement.  Her full 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 –20061102	VARD - 20070220	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low back Pain w/ Right Sciatica…Subsided…	5237	0%	Chronic Lumbosacral Strain…	5243-5237	0%	20070111	
			Scar of Lower Back…	7805	0%		
RATING:  0%	COMBINED RATING FOR ALL VA RATINGS:  0%	
*Derived from VA Rating Decision (VARD) dated 20070220.  

Low Back Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back pain began in November 2005 while lifting during Basic Training.  Surgery on 18 January 2006 for a large right-sided L4-5 disc herniation resulted in improvement in back pain and disc-related radiating nerve pain with right foot weakness (right L5 radiculopathy).  Despite treatment, the CI felt she could not keep up with the rigors of training and basic soldiering skills, so she requested an MEB.

At an orthopedic clinic follow-up on 11 April 2006 (4 months after surgery and 1 month prior to separation), the CI reported no problem walking (she required a cane prior to surgery).  She endorsed tingling or numbness in her right lower extremity that occurred after exercising longer than 10 minutes.  Physical examination reported a normal gait and spinal contour.  Tenderness and muscle spasm were absent.  Back movements in extension and rotation were not painful.  Thoracolumbar range-of-motion (ROM) showed 30 degrees of rotation bilaterally (normal 30 degrees) and 15 degrees of extension (normal 30 degrees).  Other thoracolumbar motion parameters were not documented.  Lower extremity strength, reflexes, and sensation were normal.  Testing for possible nerve root irritation was negative.
 
At the NARSUM examination dated 14 April 2006, the CI reported marked improvement in back pain, and resolution of prior right foot weakness.  Physical examination noted forward flexion of the back of 90 degrees (normal 90 degrees), but no other motion parameters were recorded.  The examination was also silent regarding gait pattern, spinal contour, tenderness, spasm or painful motion.  Foot strength, reflexes and sensation were normal.  There was no evidence of nerve root irritation.  At the VA Compensation and Pension (C&P) examination on 11 January 2007 (8 months after separation), the CI reported aching back pain rated as 3/10 (with 10 being the worst), worse in the morning, after sitting for more than 1 hour, or with repetitive bending.  She denied radiating pain or incapacitating episodes for the previous 12 months.  Physical examination showed no deformity of the back and a normal gait.  Muscle spasm was absent but tenderness over the L4-5 vertebral area was present.  Thoracolumbar flexion was 90 degrees and combined ROM was 240 degrees (normal 240 degrees).  Painful motion was noted at the extremes of flexion and extension.  Strength, reflexes and sensation were normal, and testing for possible nerve root irritation was negative. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under the 5237 code (lumbosacral strain), citing full ROM with no spasm or deformity.  The VA also assigned a 0% rating using a 5243-5237 code (intervertebral disc syndrome-lumbosacral strain) based on the VA C&P examination 8 months after separation,  and cited full ROM and lack of radiating pain as the rationale.  There was no evidence on the NARSUM or the VA exams of limitation of motion sufficient to support a minimum rating under the General Rating Formula, although the NARSUM examiner only reported flexion (not combined ROM as required by the VASRD).  However, the Board considered that the orthopedic evaluation 1 month prior to separation (and 3 days prior to the NARSUM) measured extension of 15 degrees.  Therefore, even assuming all other parameters were normal at that time, the highest combined ROM possible was 225 degrees, which supports a 10% rating (i.e. combined ROM greater than 120 degrees but not greater than 235 degrees).  It was also noted that the VA examiner recorded the presence of lumbar tenderness, which meets the 10% stipulation for “localized tenderness not resulting in abnormal gait or abnormal spinal contour.”  That examination also recorded painful motion, which IAW VASRD §4.59, warrants a 10% rating.

There was no documentation of incapacitating episodes which would provide for a higher rating under that formula.  The Board finally considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI had radiculopathy manifested by right foot weakness and radiating pain due to the herniated disc, but this resolved after surgery.  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.  There is no evidence in this case that neurologic deficits from radiculopathy existed to any degree that could be described as functionally impairing.  The Board therefore concluded 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 recommends a disability rating of 10% for the low back pain condition.

BOARD FINDINGS:  In the matter of the low back pain condition, the Board unanimously recommends a disability rating of 10%, coded 5237 IAW VASRD §4.71a.  The Board, therefore, recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation

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

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140318, 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-D0), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXXX, AR20160005901 (PD201401374)

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