RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01952
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040903

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

CI CONTENTION:  “Please 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 - 20040525	VARD - 20070713	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5237	10%	Degenerative Disc Disease, Lumbosacral Spine	5242	20%	20070604	
			Internal Hemorrhoid Associated with DDD	7336	0%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Chronic Back Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back pain condition began in April 2003 after lifting heavy ammunition.  Radiographic (X-ray) studies in July 2003 showed a normal spine.  An MRI study in November 2003 showed minimal intervertebral disc bulge at the L4-5 level without impingement on the L4 spinal nerve root.  Despite treatment, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “mechanical low back pain with myofascial pain” for PEB adjudication.

At the time of the physical medicine clinic appointment on 20 October 2003, 11 months prior to separation, the CI reported back pain that radiated into the buttocks.  The pain was relieved with stretching and transcutaneous electrical nerve stimulation (TENS) unit.  On examination the CI exhibited normal motor and sensory function, tenderness to palpation and paraspinal spasms with a slightly antalgic gait.  Lower extremity muscle strength was normal.

At a physical therapy clinic examination, on 22 October 2004, the CI stated there was no improvement in pain, and the pain intensity was 6-7/10 on a daily basis.  Physical examination showed a slight abnormal thoracic spinal curvature (kyphosis), guarded painful gait and tenderness to palpation.  A provocative maneuvers for possible signs of radiculopathy or nerve root irritation was positive on the right.  Forward flexion and extension were recorded as “limited to 50% due to pain and guarding.”

During the MEB examination (recorded on DD Form 2807 Report of Medical History and DD Form 2808 Report of Medical Examination) dated 3 March 2004, 6 months prior to separation, the CI reported ongoing back pain with tingling down the right leg, traveling into the right heel.  Physical examination showed tenderness to palpation.

The MEB NARSUM examination on 13 April 2004, 5 months prior to separation, noted complaints of 5-6/10 throbbing back pain with continued right buttock pain, with tingling in the foot and numbness of the heel.  Approximately 25% of the day the CI experienced flare-up of pain rated 10/10 in intensity.  The pain made it difficult for the CI to dress himself and he took pain medication at night to help him sleep.  Physical examination showed forward flexion limited to 75 degrees (normal 90) with a combined ROM of 195 degrees (normal 240).  The CI displayed a slightly antalgic gait with muscle spasms, tenderness to palpation and normal strength and sensation.

A VA Compensation and Pension (C&P) evaluation was performed almost 3 years after separation, which is beyond the Board’s consideration of VA evidence (within 12 months of separation).  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back pain condition 10%, coded 5237 (lumbosacral strain), citing the combined ROM of 205 degrees.  The VA rated the lumbosacral spine condition 20%, coded 5242 (degenerative arthritis of the spine), based on a C&P examination almost 3 years after separation that was not probative to the Board’s deliberations.  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) or combined ROM (greater than 120 degrees but not greater than 235 degrees) reported on the NARSUM examination.  It was noted however that muscle spasm or guarding was associated with an abnormal gait on three of the examinations in evidence.  The Board concluded that this was a sufficient basis for a 20% rating (i.e. for muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis).  

There was no evidence of intervertebral disc syndrome (IVDS) which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula (for IVDS).  There was no evidence of an associated unfitting radiculopathy for consideration of a separate peripheral nerve rating.  The Board noted that the VA rated an internal hemorrhoid associated with lumbosacral degenerative disc disease at 0%.  However, there was no evidence of a functionally limiting hemorrhoid condition at the time of separation.  Consideration of a separate service rating was therefore not warranted.  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 chronic back pain condition, coded 5237.

BOARD FINDINGS:  In the matter of the chronic back pain condition, the Board unanimously recommends a disability rating of 20%, coded 5237 IAW VASRD §4.71a.  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 the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Back Pain	5237	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140505, w/attachments
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 XXXXXXXXXXXXXXXXXX AR20160014869 (PD201401952)

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