RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01475
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090920

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Patriot Missile Launch Station Maintainer/Operator, medically separated for “chronic low back pain,” with a disability rating of 10%.  

CI CONTENTION:  His condition continues to worsen. He was not evaluated for his mental health and sleep apnea conditions.  The CI’s 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 - 20090605	VARD - 20090928	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain (LBP)	5299-5243	10%	Thoracolumbar Spine Degenerative Disc Disease	5343	10%	20090727	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic LBP.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic LBP condition began in early 2008.  The CI reported LBP without radiation to the lower extremities (LEs) or any neurological symptoms. He denied any specific injury or trauma.  Lumbar spine X-rays were normal.  The CI was treated with physical therapy without sustained improvement.  At a primary care visit on 29 October 2008, the CI reported worsening LBP with radiation to the left buttock with running and left lower extremities (LLE) numbness, and the examination noted painful back range of motion (ROM), but was otherwise unremarkable.  Magnetic resonance imaging studies on 1 November 2008 showed “mild to moderate” degenerative disc disease and degenerative joint disease (changes of the facet joints), without evidence of nerve impingement or spinal canal stenosis.  

The CI was referred for chiropractic treatment and to a pain specialist, but the symptoms continued and the CI requested a second opinion.  At a neurosurgical consult on 3 March 2009 the CI reported LBP and two episodes of LLE sciatic-type pain while running, without LE numbness, tingling, weakness, nor bowel or bladder problems.  On examination there was a normal gait.  There was bilateral sacroiliac joint tenderness, and LE strength, sensation, and reflexes were normal bilaterally.  The neurosurgeon noted there was no indication for surgery and recommended additional treatment with a pain specialist.  Despite treatment, the CI’s back condition could not be adequately rehabilitated to meet the physical requirements of his military specialty and he was referred for an MEB.  The MEB examination on 17 April 2009, 5 months prior to separation, noted complaints of chronic LBP without LE radicular symptoms.  The physical examination showed mild tenderness over both sacroiliac joints.  There was no abnormal spinal curvature and no muscle spasms were noted.  Sensation and motor strength were normal.  Straight leg raise testing for radiculopathy was negative.  The ROM was forward flexion of 75 degrees (90 degrees normal) with a combined ROM of greater than 160 degrees (240 degrees normal), limited by pain.

At the VA Compensation and Pension (C&P) examination on 27 July 2009, performed 2 months before separation, the CI reported constant pain, weakness, stiffness, fatigue, and lack of endurance of the lumbar spine, without LE symptoms.  The physical examination showed tenderness of the lumbar region.  Posture, gait, and LE motor strength, sensation, and reflexes were normal.  The ROM was forward flexion 70 degrees with a combined ROM of 220 degrees; there was painful motion on forward flexion and extension.  The examiner noted there were no episodes of physician-prescribed bed rest in the past 12 months.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the chronic LBP condition 10% coded analogous to 5343 (intervertebral disc syndrome), citing limitation of ROM.  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 combined ROM (greater than 120 degrees but not greater than 235 degrees) reported at the MEB and VA examinations.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or a spinal contour, thus the next higher 20% rating was not justified on this basis.  There was also no evidence of intervertebral disc syndrome (IVDS) which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula (for IVDS). There was no associated radiculopathy for a separate peripheral nerve rating.  While the CI may have experienced radiating LE pain from the back condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  There was no objective evidence in this case that motor weakness 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 concluded that there was insufficient cause to recommend a change in the PEB adjudication for the chronic LBP condition.  

BOARD FINDINGS:  In the matter of the chronic LBP 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 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 20140318, 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 AR20160008330 (PD201401475)

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