RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01700
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20051026

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Carpentry/Masonry Specialist, medically separated for “chronic low back pain due to lumbar degenerative disc disease,” with a disability rating of  10%.

CI CONTENTION:  The CI contends his condition continues to worsen and negatively impacts his daily activities.  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 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 - 20050922	VARD - 20060130	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain…	5299-5242	10%	Degenerative Disc Disease, Thoracolumbar Spine 	5242	40%	20051020	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in November 2002 after lifting another soldier during a training exercise.  In March 2004, magnetic resonance imaging (MRI) showed disc desiccation and spinal canal stenosis (narrowing) at L4-L5 and L5-S1.  Despite treatment, the CI’s condition could not be adequately rehabilitated.  The MEB forwarded “low back pain due to lumbar degenerative disc disease, without neurologic abnormality” for PEB adjudication.  During an outpatient rehabilitation consult on 16 March 2005, 8 months before separation, the CI reported physical therapy had not been beneficial and he continued to have low back pain that radiated to his right side only.  Physical examination showed range of motion (ROM) as “essentially within normal limits.”  Muscle testing was 5/5 and straight leg raise (assess herniated disc causing sciatic nerve root [L5-S1] radiculopathy) was positive on the right.  There were no sensory deficits and gait was within normal limits.  Reflexes were 1+ at the right knee and ankle and 2+ on the left.  Epidural steroid injections were recommended.

At the 12 April 2005 follow-up 2 weeks after the epidural steroid injection, the CI’s gait was mildly antalgic and paraspinal spasms were noted.  Flexion and extension were reported to be limited secondary to pain, but no limits were provided.  Another MRI was done in July 2005 noting “grossly unchanged from previous MRI.  At the MEB NARSUM examination in August 2005, 2 months before separation, the CI reported low back pain that was progressively worsening with no relief from physical therapy, medications or injections.  Physical examination showed a slightly antalgic gait; normal strength, sensation and reflexes; and no muscle spasms.  The thoracolumbar ROM measurements showed flexion of 70 degrees (normal 90), and combined ROM of 215 degrees (normal 240).

During the VA Compensation and Pension (C&P) examination on 20 October 2005m, 6 days before separation, the CI reported constant pain that traveled from the low back region down to his feet.  Pain was elicited by physical activity and stress.  Physical examination revealed a normal posture and gait.  He had spinal muscle spasms, tenderness and a positive left and right sided straight raise test.  The thoracolumbar ROM measurements showed flexion at 20 degrees and combined ROM of 110 degrees.  The examiner noted the spine was additionally limited by pain, fatigue, weakness lack of endurance, and incoordination; but was unable to determine any additional limitation in joint function in degrees.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating, analogously code 5299-5242 (degenerative arthritis of the spine).  The VA chose VASRD code 5242, and assigned a 40% disability rating, citing forward flexion not greater than 30 degrees.  The Board noted the disparity between the MEB NARSUM and VA C&P ROM examinations and deliberated their probative value.  The Board determined the VA C&P examination had less probative value since the ROM examination was not supported by the evidence.  The Board found no evidence that the CI experience thoracolumbar spine trauma from the time of the MEB NARSUM examination (2 months before separation) to the C&P examination (6 days before separation) to corroborate a 20 degrees flexion.  During the VA examination, CI had spinal tenderness, but muscle spasm did not result in an abnormal gait or abnormal spinal contour.  The CI reported not being able to:  vacuum, cook, dress self, take out trash, garden, or push a lawn mower; however, he was employed as a carpenter and had not lost any work time due to his back condition.  He also reported being able to brush teeth, take a shower, drive a car, climb stairs, walk and shop.

The Board determined based on the totality of the evidence that the MEB NARSUM examination (flexion at 70 degrees) had more probative value and was more indicative of the CI’s spine disability at separation.  IAW the VASRD §4.71a, a 10% rating is warranted when thoracolumbar flexion is greater than 60 degrees, but not greater than 85 degrees; as documented by the MEB NARSUM.  In considering other pathways to a higher rating, 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 did not find evidence of intervertebral disc syndrome with 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 the CI’s positive straight leg raising tests and reported radicular pain down his legs and feet.  The Board requires a functional impairment linked to fitness to support a recommendation for addition of a peripheral nerve rating to service disability in spine cases.  The pain component of a radiculopathy is subsumed under the general spine rating as specified in §4.71a.  Though there was objective evidence of motor deficit (knee and ankle reflexes +1 and +2), later examination findings (more proximate to separation) were normal; therefore, the Board could not support a recommendation for service rating on this basis.  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 low back pain condition.

BOARD FINDINGS:  In the matter of the low back 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 20140517, 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 AR20160011072 (PD201401700)

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 i 554a,
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