RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01587
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090806

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Chemical Operations Specialist, medically separated for “back pain,” with a disability rating of 10%.  

CI CONTENTION:  The CI’s condition continues to worsen and negatively impact his daily activities.  The CI further contends his rating was too low.  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 - 20090501	VARD - 20090828	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Back Pain Evaluated as Lumbosacral Strain	5299-5237	10%	Degenerative Joint and Degenerative Disc Disease of the Lumbar Spine…	5242	10%	20090630	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Back Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began insidiously while stationed in Germany in 2000.  Magnetic resonance imaging (MRI) studies on 24 August 2006 showed multilevel degenerative joint and degenerative disc disease most prominent at L4-L5 that had radiographically progressed to “severe” in October 2008.  Manipulation therapy and medications were prescribed; and epidural steroid injections (in December 2007, January, and June 2008) were performed.  At the time of the orthopedic clinic appointment on 20 October 2008 (10 months pre-separation), the examiner recorded spinal tenderness, painful motion, a normal appearing spine, normal strength and reflexes, with a normal heel and toe walk.  Straight leg raise testing was negative and there were no muscle spasms present.  At the time of the neurosurgical evaluation on 6 January 2009 (7 months pre-separation), the CI reported 3-4/10 back pain, intermittent (very infrequent) numbness and tingling in the legs, stiffness, weakness, and loss of strength.  On examination, there were no muscle spasms and testing (straight leg raise) did not elicit radiculopathy.  Gait and range of motion (ROM) were normal.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “lumbar disk disease, multilevel” for PEB adjudication.  

At the MEB examination (recorded on DD Forms 2807 and 2808) dated February 2009 (6 months pre-separation), tenderness and decreased ROM were noted.  The MEB NARSUM examination on 16 March 2009 noted complaints of constant 3-9/10 back pain with radiation to the posterior hips.  The CI reported that pain was exacerbated by lifting, walking or running and that flare-ups caused markedly decreased ROM, fatigue, weakness and lack of endurance resulting in inability to train to his fullest ability.  On examination there was tenderness with mild loss of lumbar lordosis, and absence of muscle spasms.  Flexion was to 65 degrees with limited extension, and bilateral flexion with pain after repetition.  Testing for radiculopathy (straight leg raise) was negative bilaterally.  Strength and reflexes were normal bilaterally.  

At the VA Compensation and Pension (C&P) examination in June 2009 (1 month pre-separation), the CI reported low back pain with numbness, zapping and tingling from his low back to his toes.  Physical exam showed right sided muscle tenderness, with a normal gait and no muscle spasms.  Strength, sensory and reflexes were all normal.  Flexion was to 90 degrees with pain, and no additional limitations after repetition.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5299-5237 code (lumbosacral strain), citing forward flexion of 65 degrees.  The VA assigned a 10% rating using the 5242 code (degenerative arthritis of the spine) based on the VA C&P examination a month prior to separation, citing tenderness to palpation.  

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) reported on the NARSUM exam and the painful motion reported on the VA C&P examinations proximate to separation.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  The Board considered whether a higher rating (§4.7) was achieved by using the alternate rating formula based on incapacitating episodes due to intervertebral disc syndrome (IVDS).  Although the CI had intervertebral disc disease there were no incapacitating episodes requiring physician-prescribed bed rest having a total duration of at least 2 weeks but less than 4 weeks in the 12 months prior to separation to warrant consideration of a higher rating under the alternate VASRD formula (for IVDS).  The Board also considered if an additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI had symptoms of radiating pain documented in the treatment records; however, exam findings indicated normal strength, reflexes, and sensation.  There was no associated radiculopathy for separate peripheral nerve rating.  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 was no objective evidence of a radiculopathy with functional impairment (such as weakness) that directly impacted fitness for duty.  The Board therefore concluded that an 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 lumbar condition.  

BOARD FINDINGS:  In the matter of the lumbar spine 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 20140221, 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 XXXXXXXXXXXXXXXXXXXXX AR20160013475 (PD201401587)

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