RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01722
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070110

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Armor Crewman, medically separated for “chronic radiating low back pain” with a disability rating of 10%.  

CI CONTENTION:  The CI noted a 40% rating from the VA for his back and to consider all conditions.  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 upon a 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 - 20061005	VARD - 20070619	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Radiating Low Back Pain (LBP)	5234	10%	Lumbar Spine…(Claimed as Chronic LBP with DDD)	5237	20%	20070418	
Chronic PTSD	Not Unfitting	PTSD	9411	30%		
Right Renal Calculus		Right Nephrolithiasis	7508	0%		
Hearing Loss, Right Ear		Right Ear hearing Loss…	6201-6100	0%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s lower back pain began in March 2005 while in Kuwait after he jumped out of a semi-truck.  In June 2005, he was involved in a motor vehicle accident, which aggravated his pain.  He did not seek treatment until October 2005.  MRI of the lumbar spine in May 2006 showed degenerative disc disease at L4-5 and L5-S1, with nerve involvement on the left L5 nerve root.  He was not a surgical candidate.  Injection therapy and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic low back pain with degenerative disc disease at L4-5 and L5-S1 and herniated nucleus pulposus at these two levels” for PEB adjudication.  
At the MEB examination (recorded on DD Forms 2807 and 2808) dated 25 July and 31 July 2006 respectively, 6 months prior to separation, the CI reported he had numbness in his toes on the right foot and in his right hand.  He also reported back pain.  The physical examination recorded decreased range of motion (ROM) on forward flexion.  

The MEB orthopedic NARSUM examination on 17 August 2006, 5 months prior to separation, noted complaints of lower back pain with radiation into bilateral buttocks region, and into both legs to his knees.  Physical examination showed forward flexion to “approximately 1 foot from the ground”, and extension to 10 degrees (30 normal), and 30 degrees of left and right side bend (30 normal).  Motor strength was recorded as 5/5 with intact sensory to light touch in all lower extremity nerve distribution.  

The MEB NARSUM examination on 31 August 2006, 5 months prior to separation, noted the CI’s report of centrally located back pain described as sharp and stabbing with no radicular symptoms. His back pain was aggravated with prolonged walking (he could walk 2 miles at his own pace), running, lifting and carrying.  Prolonged standing and sitting also aggravated his pain.  Physical examination documented active ROM forward flexion to 45, 34, and 40 degrees (normal=90) and normal extension.  The measurements were accompanied by pain.  Spasm was absent, and both motor and sensory function was normal.  Tests of radiculopathy were negative and gait and posture were recorded as normal.  

At the 18 April 2007 VA Compensation and Pension (C&P) examination performed, 3 months after separation, the CI reported that he had chronic pain and stiffness and back spasms.  His pain was constant.  ROM documented flexion to 60 degrees and extension of 20 degrees.  The examiner noted range of motion was due to pain and weakness of muscles; however, there was no further loss in ROM and no instability, fatigue, or incoordination following repetitive motion.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP 10% coded 5243 (intervertebral disc syndrome), citing pain on limited motion.  The VA rated the LBP 20% coded 5237 (lumbar spine strain), based on the VA C&P examination, 3 months after separation, citing limited and painful motion of the lumbar spine.  The Board agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees), reported on the MEB NARSUM and the C&P examinations.  The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI reported radiating pain.  The NARSUM examination revealed no objective findings of radiculopathy that would impact duty performance.  While the CI may have suffered additional pain from the nerve involvement, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  Therefore the critical decision is whether or not there was a significant motor weakness which would impact military occupation-specific activities.  There was no evidence in this case that motor weakness existed to any degree that could be described as functionally impairing.  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 recommends a disability rating of 20% for the back condition.  

Contended PEB Conditions.  Posttraumatic Stress Disorder (PTSD), right renal calculus, and right ear high frequency hearing loss conditions.  

PTSD.  According to the mental health MEB, the CI reported his symptoms began after his return from combat in Iraq.  The psychiatrist assessed chronic PTSD, mild and noted that his condition did not rise to the level of failing retention standards.  There was no indication from the record that the CI ever received treatment for his condition.  

Renal calculus.  The record noted in April 2006, the CI complained of right flank pain which was diagnosed as a renal stone (calculus).  At the time of the evaluation, the CI denied gross hematuria and fever.  Systemic symptoms were absent.  A right kidney stone was seen on the CT.  

Hearing Loss.  The CI reported exposure to IED blasts that reportedly led to intermittent tinnitus.  Audiogram was consistent with high frequency hearing loss in the right ear.  

The PTSD, right renal calculus, and right ear high frequency hearing loss conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.  There was no performance based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the chronic radiating low back pain condition, the Board unanimously recommends a disability rating of 20%, coded 5243 IAW VASRD §4.71a.  In the matter of the contended PTSD, right renal calculus, and right ear high frequency hearing loss conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Chronic Radiating Low Back Pain	5243	20%	
RATING	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140404, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

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, AR20160013478 (PD201401722)

1. 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,
accept the Board’s recommendation to modify the individual’s disability rating to 20%
without re-characterization of the individual’s separation. This decision is final.

2. I direct that all the Department of the Army records of the individual concerned be
corrected accordingly no later than 120 days from the date of this memorandum.

3. I request that a copy of the corrections and any related correspondence be provided
to the individual concerned, counsel (if any), any Members of Congress who have
shown interest, and to the Army Review Boards Agency with a copy of this
memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

CF:
( ) DoD PDBR
( ) DVA