RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01565
BRANCH OF SERVICE:  Army		        Separation Date:  20040915

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Signal Support Systems Specialist, medically separated for back pain, rated at 10%.  

CI CONTENTION:  The CI contended her rating should include feet and back conditions.  The 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 – 20040811	VARD - 20050207  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain with Radiation to LLE…	5299-5237	10%	Degenerative Disc Disease of L5-S1	5242	10%	20041019	
RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Chronic Back Pain with Radiation to LLE Condition.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in July 2002 after she sustained a twisting injury to her lower back.  The condition was associated with symptoms in the left lower extremity.  Although electrodiagnostic studies demonstrated evidence consistent with a left L4-5 lumbar radiculopathy, radiographic studies showed minimal degenerative changes and a bulging disc at L5-S1 that did not appear to affect the nerve root.

The MEB NARSUM examination on 11 March 2004 approximately 6 months prior to separation noted low back pain that was present 50-75% of the day.  It was exacerbated by prolonged standing, walking sitting or traveling.  Burning pain radiated into the left hip, leg and foot, and was associated with occasional tingling and decreased sensation in the toes.  Examination showed a normal gait.  Lumbar spine tenderness and painful motion were present, but the exam was silent regarding muscle spasm and spinal contour.  Flexion was 80 degrees (normal 90 degrees) and combined range-of-motion (ROM) was 210 degrees (normal 240 degrees).  Detailed lower extremity neurologic findings, including muscle strength, sensation and reflexes, were normal.  Walking on heels and toes was normal.  There was no evidence of nerve root irritation.  An examination by primary care on 23 March 2004 documented numbness in an L4-5 distribution in the left leg and foot.  Muscle weakness was not mentioned.  A neurosurgical evaluation on 3 June 2004 noted that the radiating left lower extremity pain did not correlate with known neurologic anatomy.  Examination showed normal lower extremity muscle strength, sensation and reflexes.  The examiner concluded that surgical intervention was not indicated.  An updated NARSUM exam on 25 June 2004 (3 months prior to separation) recorded identical ROM measurements as the original NARSUM.  Lumbar tenderness was present and gait was normal.  Walking on heels and toes was normal and signs of nerve root irritation were absent.  At the VA Compensation and Pension (C&P) examination on 19 October 2004, performed approximately 1 month after separation, the CI reported continuing back pain.  Current radicular symptoms were not reported.  Missed work due to the condition during the previous year was denied.  Physical exam showed a normal gait.  A “very slight scoliosis” (abnormal spine curve) was observed, but there was no muscle spasm.  Tenderness or guarding was not reported.  ROM testing showed flexion of 90 degrees and combined ROM was 240 degrees.  Although painful motion was not specified, “tightness” was noted at extremes of flexion and extension.   

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5237 code (lumbosacral strain), noting thoracolumbar ROM limited by pain with localized tenderness.  The VA also assigned a 10% rating using the 5242 code (degenerative arthritis of the spine), although the rating rationale was not specified.  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 on the NARSUM exam.  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 this basis. 

There likewise was no documentation of incapacitating episodes which would provide for a higher rating under that formula.  The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI reported radiating pain with numbness to the left leg, and electrodiagnostic studies noted evidence of an L4-5 radiculopathy.  However, except for one examiner who reported only some decreased sensation, all examiners documented completely normal neurologic findings, including muscle strength.  The presence of functional impairment with a direct impact on fitness is the key determinant in the Board’s decision to recommend any condition for rating as additionally unfitting.  While the CI may have experienced radiating 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 is no evidence in this case that neurologic deficits from radiculopathy existed to any degree that could be described as functionally impairing.  The Board therefore concluded, like the VA, 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 back pain condition.

BOARD FINDINGS:  In the matter of the back pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140329, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander, US Army Physical Disability Agency (AHRC-00), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXXXXX AR20160005529  (PD201401565}

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 
( ) OVA