RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01463
BRANCH OF SERVICE:  Army	Separation Date:  20070901

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Field Artillery Automated Tactical Data Specialist) medically separated for chronic low back pain (LBP).  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty; however, his physical profile authorized him to perform two alternate aerobic Army Physical Fitness Test events.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The condition characterized as “chronic low back pain secondary to multilevel degenerative disk disease (DDD)” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded six other conditions (atypical chest pain, gastro esophageal reflux disease, chronic right knee pain, chronic bilateral tinnitus, hypertension and hyperlipidemia) for PEB adjudication.  The Informal PEB adjudicated “chronic LBP secondary to multilevel degenerative disk disease” as unfitting, rated 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be not unfitting.  The CI made no appeals and was medically separated.  

CI CONTENTION:  “My back was worse than explained to me.  Also, they did not give me any rating for sleep apnea or PTSD.” 

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 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:  

IPEB – Dated 20070718	VA* - (~5 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP Secondary to Multilevel DDD	5299-5237	10%	DDD	5010	10%	20080207	
Other x 6 (Not In Scope)	Other x 6 	
RATING:  10%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20080405 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Chronic LBP Secondary to Multilevel DDD Condition.  The CI injured his lower back in 2005 while in Korea.  He developed LBP with pain radiation down both legs.  He underwent two epidural steroid injections while in Korea which failed to relieve the LBP.  A repeat magnetic resonance image performed in August 2006 for complaints of right leg paresthesia (abnormal sensation) and weakness after standing for greater than 20 minutes showed multi-level DDD, bulging discs at L2-S1 with stenosis (narrowing) throughout.  The lumbar spine X-ray performed in October 2006 showed DDD, mild narrowing of the L5-S1 disc space and disc herniation at L5.  The physical therapist in November 2006 noted occasional complaints of numbness in the right leg that would resolve spontaneously in about one hour.  The physical therapy physical exam findings are summarized in the chart below.  An electromyogram done in February 2007 demonstrated a normal study; there was no evidence of a right lumbar radiculopathy, focal neuropathy, lumbosacral plexopathy or generalized polyneuropathy.  

The MEB narrative summary (NARSUM) exam approximately 4 months prior to separation documented that the CI reported chronic, constant searing pain throughout the lower lumbar region that became significantly more intense with exertion on a pain rating scale of 5-9/10.  The LBP was aggravated by standing or sitting for greater than 20 minutes without repositioning or stretching, walking for greater than one mile with rest, impact activities, wearing body armor, carrying heavy objects greater than 15 pounds, sit-ups, push-ups, flutter kicks, repetitive bending, lying in a supine position and drawing a protective mask out of its carrier.  The MEB physical exam findings are summarized in the chart below.  A repeat lumbar spine X-ray done in May 2007 was unchanged from the October 2006 report.  The neurosurgeon in June 2007 indicated that the CI had tenderness at the lumbosacral junction without spasm and without motor deficit.  

The VA Compensation and Pension (C&P) exam approximately 5 months after separation documented that the CI reported LBP, numbness and paresthesia with radiation into the right lower extremity.  The VA C&P physical exam findings are summarized in the chart below.  The range-of-motion (ROM) evaluations in evidence with documentation of additional ratable criteria which the Board weighed in arriving at its rating recommendation are summarized in the chart below.  

Thoracolumbar ROM
(Degrees)	PT ~10 Mo. Pre-Sep	MEB ~4 Mo. Pre-Sep	VA C&P ~5 Mo. Post-Sep	
Flexion (90 Normal)	80 with pain	Full ROM	90	
Combined (240)	>120; <235		240	
Comment	Pain-limited motion; increased pain on Lasegue’s test; motor, reflex and sensory exams normal	Painful motion; mild tenderness; sensory intact; reflexes symmetric; gait normal	No spasm or tenderness; no painful motion; motor normal	
§4.71a Rating	10%	10%	0%-10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the low back condition as 5299 analogous to 5237 (lumbosacral strain) and rated at 10%.  The VA coded the back condition as 5010 (arthritis, due to trauma, substantiated by X-ray findings) and rated at 10% citing mild right intermittent radiculitis by history and DDD by X-ray.  The MEB examiner documented painful motion and mild tenderness, meeting the 10% rating criteria of “localized tenderness not resulting in abnormal gait or abnormal spinal contour.”  There was no evidence of incapacitating periods or more limited thoracolumbar spine ROMs for higher rating.  The General Rating Formula for the Spine includes all thoracolumbar spine pathology and includes symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the affected spine.  Although the CI reported occasional right leg numbness (paresthesias) and weakness, there was no objective evidence of fixed motor weakness or focal neurologic deficit for additional rating.  Since no evidence of functional impairment from any radiculopathy existed in this case, the Board cannot support a recommendation for additional rating based on peripheral nerve impairment.  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 chronic LBP 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 20140326, 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, AR20160003121 (PD201401463)

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