RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	     CASE:  PD-2014-01479	
BRANCH OF SERVICE:  Army	      separation DATE:  20080826		   

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E-4, Cannon Crewmember, medically separated for “chronic low back pain…(radiculopathy not independently ratable),” with a disability rating of 20%.

CI CONTENTION:  “This injury has crippled me for life.  I haven’t had a job since this happened to me.  I should have been given retirement.  On the second page of attached doc, it should have been A, because it is a disability from injury during period of war.”[sic] The applicant’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 - 20080516	VARD - 20080929	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5243	20%	Intervertebral Disc Degeneration	5243	0%	20080627	
COMBINED RATING:  20%	COMBINED RATING FOR ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:   

Low Back Pain (LBP).  This CI has a long history of LBP, dating back to July 2004.  No specific trauma or injury was associated with the initial onset of back pain.  His symptoms were attributed to running, and lifting heavy ammunition.  In February 2006, while deployed overseas, he injured his back in a motor vehicle accident.  Magnetic resonance imaging (MRI) showed lumbar spinal stenosis (probably congenital), with overlying spondylotic degenerative changes.  The CI was able to successfully complete his overseas deployment.  After returning to the US, he was seen on many occasions for his LBP.  He was treated with medication, profiles, physical therapy (PT), and other conservative measures.  In spite of all treatment efforts, he continued to have problems with LBP.  Repeat MRI (October 2007) showed that the narrowing at L5-S1 appeared to be slightly worse than the previous MRI.  Due to the chronic, persistent nature of his symptoms, an MEB was initiated.

The MEB physical examination (PE) was on 25 March 2008.  The CI reported pain in the lower back, with numbness/tingling/burning in both legs, left greater than right.  He was taking Percocet when pain was severe, but this made him drowsy so he tried not to take it during the daytime.  On PE, his gait was normal.  PE of the lower back revealed no pain with palpation, and no spasms.  Neurological exam of the lower extremities (LEs) was essentially normal, except for a slightly decreased left ankle jerk.  Muscle strength was normal in both LEs.  There was pain with motion of the lower back.  On forward flexion, fingertips reached the top of his kneecaps.
 
The CI was medically separated from service in September 2008.  Ten weeks before separation, on 27 June 2008, he had a VA Compensation and Pension (C&P) exam.  He reported that he could not stand for a long time, or bend over, or sit for a long time.  He could do all the activities of daily living, such as brush teeth, cook, shower, shop, vacuum, dress self, gardening, and take out trash.  The CI told the examiner that he was in the military, and he continued to work without problems, except that walking, climbing stairs, driving a car, or pushing a lawnmower would cause back pain and ankle problems. In general, he could sustain heavy physical activities without immediate distress.

On PE, posture and gait were normal.  PE of the thoracolumbar spine showed no evidence of muscle spasm, tenderness, or radiation pain on movement.  Straight leg raise (SLR) was negative bilaterally.  Spinal curvature was normal, and there was symmetry in appearance and spinal motion.  Back range-of-motion (ROM) was normal.  

With regard to the physical examinations described above, the June 2008 C&P exam was closest to the date of separation (DOS), and therefore had significant probative value.  At that exam, posture and gait were normal.  PE of the back showed no evidence of muscle spasm, tenderness, or radiating pain with motion.  SLR was negative bilaterally, and spinal curvature was normal.  There was symmetry in spinal appearance and spinal motion.  Back ROM was normal.  Using data from that exam, the Board determined that the Chronic LBP condition was essentially non-compensable, based solely upon limitation of back motion.  In accordance with DoDI 6040.44 the Board may not recommend a lower combined rating than that conferred by the PEB, thus, it may not lower PEB ratings in this case.  In addition, IAW VASRD §4.10 (Functional impairment), §4.40 (Functional loss) and §4.59 (Painful motion); when part of the musculoskeletal system becomes painful with use it must be considered seriously disabled.  A compensable rating is warranted when there is satisfactory evidence of functional loss and functional impairment due to pain.  The Board determined that a compensable disability rating was appropriate and was rated correctly by the PEB based on evidence at the time.    

The Board also considered the matter of radiculopathy.  After review of all the information in the record, there was insufficient evidence of a clinically significant radiculopathy that interfered with performance of military duties.  The CI did have neurological symptoms. However, the record did not show sufficient evidence that the radiculopathy caused any significant interference with performance of military duties.  Therefore, the Board concluded that there was no unfitting radiculopathy present at DOS.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication of the unfitting LBP condition.  IAW DoDI 6040.44, the Board is not permitted to lower the disability rating assigned by the PEB.

BOARD FINDINGS:  In the matter of the chronic LBP condition and IAW VASRD §4.10, §4.40, and §4.59; 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 20140325, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

		
SAMR-RB

28 JUL 2016

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, AR20160006077 (PD201401479)

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