RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-01810
BRANCH OF SERVICE:  Army	BOARD DATE:  20150127
SEPARATION DATE:  20061104

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Chemical Operations Specialist) medically separated for a back condition.  The back condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The back condition, characterized as “chronic lower back pain” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “chronic radiating low back pain” as unfitting, rated 0% citing criteria of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the 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/Naval 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 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 IPEB – Dated 20060810	VA - (26 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Radiating Low Back Pain	5237	0%	Thoracolumbar Degenerative Disk Disease	5243	20%	20090102	
			Left Leg Radiculopathy	8520	10%	20090102	
Other x 0  (Not in Scope)	Other x 7 	
Rating:  0%	Combined:  60%	
Derived from VA Rating Decision (VARD) dated 20090311 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Chronic Radiating Low Back Pain.  The CI had fallen off a truck in December 2003 while deployed.  He subsequently experienced low back pain that initially resolved but worsened with increased physical activity in April 2005.  At the MEB exam, 9 months prior to separation, the CI reported “daily numbness down to [his] right hip and occasionally down to [his] left hip.”  The history indicated the CI “states he has lost control of bowel for the past month.  No urology or GI consult.  No neuro consult.  … bowel movement daily … no loss of bladder control.”  The MEB physical exam documented the ability to “bend at waist and touch his toes” without mention of painful motion.

The orthopedic addendum, performed 7 months prior to separation, stated that the CI had radicular pain bilaterally to his knees and numbness of the left anterior thigh.  The examination documented a normal gait, “full range-of-motion” of his back, normal sensation and muscle strength bilaterally and no pain with hip flexion, Patrick’s test (hip and sacroiliac joint pathology), straight leg raise (for S1 or L5 root irritation), or femoral stretch (L2-L4 testing).  The narrative summary (NARSUM), performed 4 months prior to separation stated that the CI had daily pain that radiated to both of his knees.  He had no bladder or bowel incontenance.  Medications and physical therapy had not relieved the pain and surgery was not indicated.  The exam documented normal gait and posture, and goniometric thoracolumbar flexion of 90 degrees (normal) and combined 235 degrees [with application of DeLuca repetitive motion criteria to extension of “35, 30, and 25”] (240 normal).  There was no spasm or deformity, no tenderness and symmetric reflexes bilaterally.  Radiographic evaluation showed degenerative disc disease (DDD) of T12-L1 and L1-L2 with disc herniation with mild central canal narrowing (causing pressure on the spinal cord) at T12-L1.  The radiologist also stated “as these are unusual locations for degenerative changes, post-traumatic etiology is suspected.”

At the VA Compensation and Pension exam performed 26 months after separation, the CI reported intermittent radiating pain down his lower extremities bilaterally on a weekly basis and occasional bowel incontinence.  He denied weakness of the lower extremities, use of assistive devices, and incapacitating episodes during the previous year.  The examination documented tenderness of the L1-L2 spine and lumbar muscle spasm, pain with straight leg raise bilaterally, normal gait, flexion 0 degrees to 90 degrees with painful motion, extension 0 degrees to 30 degrees with pain and popping , and no reflex at the left ankle.  On repeat testing there was no weakness, incoordination, instability, or additional loss of range-of-motion (ROM).  Radiographs documented degeneration of the thoracic spine with “minimal levocurvature of the T-spine; accentuation of concavity of the endplates in the lower thoracic region without definite collapse; and generalized osteopenia” (abnormal contour).  The examiner opined that the CI’s left leg pain, radiculopathy, and areflexia were a result of the DDD.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition at 0% coded 5237 (lumbosacral strain) citing normal gait, full motion, no tenderness or spasm and no clinical signs of radiculopathy, with imaging that showed mild multilevel non-compressive DDD.  Two years after separation, the VA rated the back condition at 20% coded 5243 (intervertebral disc syndrome) for muscle spasm severe enough to result in abnormal spinal contour, and an additional 10% rating under code 8520 (Paralysis of Sciatic Nerve- Mild).  The history of trauma, painful motion, decreased combined ROM, and evidence of DDD noted at the NARSUM examination supported a 10% rating coded 5242 (degenerative arthritis of the spine) IAW VASRD §4.71a.  The remote VA exams were adjudged post-separation worsening and not indicative of the CI’s disability picture at the time of separation.  The Board found insufficient evidence to support a rating higher than 10% based on limitations of motion, abnormal spine contour, abnormal gait, or incapacitating periods proximate to separation.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the chronic lower back pain condition.

The Board considered if the PEB disability description, which included radiating pain, having been de-coupled from the combined PEB adjudication, remained itself unfitting.  The PEB stated that there were no clinical signs of radiculopathy prior to separation.  The well-established principle for fitness determinations is that they are performance-based.  Although occasional radiating pain and subjective numbness were reported prior to separation, there were no objective neurologic abnormalities documented by the MEB or NARSUM examiners which would logically be associated with significant disability.  There was insufficient evidence to indicate impairment of duty due to a radiculopathy.  The pain component of the radiculopathy was considered under the general spine rating formula rating above.  The Board therefore adjudged that there was insufficient evidence to designate the radiating pain as separately unfitting and therefore no additional rating for radiculopathy is recommended.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  In the matter of the chronic lower back pain condition, the Board unanimously recommends a disability rating of 10%, coded 5242, IAW VASRD §4.71a, with no unfitting radiculopathy.  There were no other conditions within the Board’s scope of review for consideration.

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

UNFITTING CONDITION	VASRD CODE	RATING	
Chronic Radiating Low Back Pain	5242 	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140421, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

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 XXXXXXXXXXXXXXX, AR20150009949 (PD201401810)

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,   I accept the Board’s recommendation to modify the individual’s disability rating to 10% without recharacterization 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:

Encl			     XXXXXXXXXXXXXXX
			     Deputy Assistant Secretary of the Army
			         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA