RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01486
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060301
BOARD DATE:  20160420

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Aircraft Powertrain Repair, medically separated for “chronic low back pain…” with a disability rating of 10%.

CI CONTENTION:  “Incorrect rating, VA exam did not show correct range of motion and it does not reflect the surgical scar.”  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 - 20051101	VARD - 20060901	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5239-5241	10%	L4 PARS Fracture S/P Iliac Crest Bone Graft	5243	0%	20060816	
			Left Thigh Pain with Numbness and Left Hip Numbness	5299-5250	NSC	20060816	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:

Chronic Low Back Pain.  According to service treatment records and the MEB narrative summary (NARSUM), the CI underwent back surgery in January 2005 for fusion and repair of a bilateral PARS defect and spondylolysis of L4 vertebra.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty and he was referred for a Medical Evaluation Board (MEB).  The MEB forwarded “spondylolysis L4-5 with grade I spondylolisthesis” for Physical Evaluation Board adjudication.

At the neurosurgery clinic appointment on 27 July 2005, 6 months post-surgery and 7 months prior to separation, the CI reported he was “doing well” and felt “70% better” than pre surgery.  He was gradually resuming normal activities, was able to work full days, but was not running yet.  On examination his lumbosacral spine exhibited no abnormalities.  There were no spasms and straight leg and reverse straight leg raise tests were negative.  Lumbosacral spine range of motion (ROM) noted forward flexion to his “toes bilaterally.”  The Board agree this approximates to 90 degrees of thoracolumbar flexion (normal 90).  ROM testing did not elicit pain on motion.  Motor strength testing and reflexes of all muscle groups in the lower extremities were normal.

At the MEB examination (recorded on DD Forms 2807 and 2808) dated August 2005, 7 months post-surgery and 6 months before separation, the CI reported left thigh numbness and tingling which was improved since surgery.  Physical exam noted well healed surgical scar of the lower back and reduced ROM.

The MEB NARSUM examination on 30 August 2005, 7 months after surgery and 6 months before separation noted the CI could not perform the two mile run or sit-ups as part of the physical fitness test.  The CI reported pain during walking and sleeping; slight pain with activities of daily living and moderate to severe during athletic activities.  Physical examination showed the CI had a normal gait with erect posture.  ROM testing revealed flexion and extension with “limitation”.  Straight leg testing, heel-toe walk and reflexes were normal.  Sensory testing was normal except for the lateral upper third portion of the left thigh.  The examination was silent regarding painful motion, motor strength of lower extremities, abnormal spinal contour, spasms or tenderness of the thoracolumbar spine.

A physical therapy examination on 19 October 2005, 9 months after surgery and 4 months before separation performed for the MEB, revealed thoracolumbar ROM flexion to 30 degrees after three repetitions, and combined ROM of 135 degrees.  A neurosurgery examination on 8 November 2005, 10 months after surgery and 3 months before separation, documented the CI doing well with good resumption of daily activities without pain.  He was able to walk, bend and sit without much discomfort.  Overall he was “extremely pleased” with the results of his surgery. His daily pain was 0-1/10 and he was not taking any pain medications.  

At the VA General Medical Compensation and Pension (C&P) examination on 16 August 2006, performed 5 months after separation, the CI reported being “better” since his surgery.  He had intermittent numbness in the bilateral lower extremities and low back pain flare-ups on a weekly basis.  There were no specific precipitating or alleviating factors but he was not inhibited by his flare-ups.  He was working full time, did not miss work and his back condition had no significant effects on his activities of daily living.  Physical exam showed the CI’s posture and gait were normal without ambulatory assistance.  His spine curve was normal and there were no muscle spasms present.  ROM showed forward flexion to 90 degrees with combined ROM to 240 degrees (normal 240).  There were no limitations on repetition of ROM testing (negative DeLuca).  The CI had mild tenderness to palpation over the lumbar scar site.  He showed no guarding and no painful motion.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating analogously coded 5239-5241 (spondylolisthesis or segmental instability to spinal fusion), citing passive limitation of forward flexion to 31 degrees not due to pain, with a non-focal neurologic examination.  The PEB considered the CI’s spondylolysis condition as existing prior to service; however, IAW 10 USC §1207a, the CI had over 8 years of active duty service therefore his condition was considered service aggravated and compensable.  The VA assigned a 0% rating coded 5243 (intervertebral disc syndrome) based on the VA C&P examination 5 months after separation, citing forward flexion of the thoracolumbar spine of greater than 85 degrees; or combined range of motion of the thoracolumbar spine greater than 235 degrees, with no muscle spasms, no guarding and no pain noted.

The Board considered the MEB NARSUM, Physical therapy and VA C&P examination evidence to support a higher rating.  The MEB NARSUM and VA C&P examinations revealed insufficient limitation of motion to support a minimum rating.  However, the Board agreed there was sufficient evidence of painful motion with functional loss to support a 10% rating (based on §4.59 and §4.40).

The Board considered the physical therapy examination which documented flexion at 30 degrees as an outlier given all other ROM examinations, before and after, revealed flexion measurements well above 30 degrees.  The Board determined the CI’s overall disability picture was appropriately rated at 10% under the VASRD’s general rating formula for diseases and injuries of the spine.  There was no evidence of muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour to recommend a 20% rating.  Additionally, there was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula or evidence of ratable peripheral nerve impairment which would provide for additional rating.  After due deliberation, and in consideration of all 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 low back pain condition.

BOARD FINDINGS:  In the matter of the chronic low back pain 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 20140328, 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 AR20160008332 (PD201401486)

I have reviewed the enclosed Department of Defense Physical Disability Board of
Review (000 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