RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01501
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080319

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E5, Military Police, medically separated for “lumbosacral strain,” with a disability rating of 10%.

CI CONTENTION:  The CI contends that his back condition should have been rated higher.  His 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 based on 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 - 20080229	VARD - 20081231	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbosacral Strain	5237	10%	Lumbar Spine Degenerative Changes	5242	10%	20080911	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Lumbosacral Strain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back pain (LBP) began in March 2007 after a fall.  Magnetic resonance imaging (MRI) showed bulging intervertebral discs at L1-L2 to L5-S1, with narrowing of the neuroforamina (space through which the spinal nerve root passes) at multiple levels.  There was scoliosis and degenerative disc disease (DDD) noted in the mid-lumbar region.  Electrodiagnostic studies performed on 8 January 2008 were negative for radiculopathy.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The CI underwent an MEB. The MEB forwarded “low back pain associated with retrolisthesis at L2-L3, multi-level lumbar degenerative disc disease, and degenerative joint disease” for PEB adjudication.
At the January 2008 MEB examination, the CI reported constant, dull pain in the midline of the back, from L2 to L4.  The pain was aggravated by climbing stairs, bending, or riding in a vehicle for extended periods.  The pain was relieved by hot showers, lying down, massage, heating pads and medication (Ibuprofen).  Surgery was not recommended.  Physical examination (PE) showed no tenderness to palpation, spasm, or guarding.  The spinal contour, gait, reflexes, and sensation were all normal.  Provocative maneuvers for signs of radiculopathy due to spinal nerve root involvement were negative.  There was full range of motion (ROM) of the thoracolumbar spine.  The NARSUM examiner’s diagnostic assessment was: “Low back pain associated with retrolisthesis at L2-L3, multilevel degenerative disc disease, and degenerative joint disease.”

At the September 2008 VA Compensation and Pension (C&P) evaluation, performed 6 months after separation, the CI reported LBP that radiated down the back of his legs to his Achilles.  The pain was aggravated by prolonged walking, standing, bending, and riding a motorcycle for long periods.  The pain prevented him from jumping or running.  He denied any weakness in the legs.  There had been no incapacitation in the previous 12 months. PE showed normal posture and gait.  There was no evidence of redness, warmth, swelling, or tenderness.  Thoracolumbar ROM was normal. 

The Board directed attention to its rating recommendation based on the above evidence.   The PEB used VASRD code 5237 (lumbosacral strain), and rated the LBP condition at 10%, citing limited forward flexion with repeated use.  The VA also rated the back pain condition at 10%, but chose VASRD code 5242 (degenerative arthritis of the spine), citing degenerative changes with painful motion.  The Board noted that the January 2008 MEB examination was just 6 weeks before the date of separation (DOS), and therefore had significant probative value.  At that exam, thoracolumbar ROM was normal, so there was insufficient ROM limitation to support a 10% rating.  However, the Board determined that there was sufficient evidence of pain with motion. IAW VASRD §4.10 (Functional impairment), §4.40 (Functional loss), and §4.59 (Painful motion), when part of the musculoskeletal system becomes painful on use, it must be regarded as seriously disabled.  A 10% rating is warranted when there is satisfactory evidence of functional loss and disability due to pain.  There was no path to a higher rating for the low back condition, since there was insufficient evidence of a seriously disabling spinal abnormality which would justify a higher rating.  There was no muscle spasm or guarding severe enough to result in abnormal gait or spinal contour, thus the next higher 20% rating was not justified on that basis.

The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI had bulging intervertebral discs with radicular symptoms of radiating pain.  However, examinations indicated normal strength, reflexes and gait.  There was no performance-based evidence that the radicular symptoms had any effect on satisfactory performance of military duties.  Therefore, the Board concluded that there was no unfitting radiculopathy present at the DOS.  After due deliberation, and consideration of all the evidence, and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication for the back pain condition (lumbosacral strain).  

BOARD FINDINGS:  In the matter of the lumbosacral strain 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

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 AR2016001 0871 (PD201401501)

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