RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-01953
BRANCH OF SERVICE:  Army	BOARD DATE:  20150120
SEPARATION DATE:  20050705

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Petroleum Supply Specialist) medically separated for lumbar spine condition.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “discogenic low back pain with radicular symptoms” was the sole condition forwarded by the MEB to the Physical Evaluation Board (PEB) IAW AR 40-501.  The Informal PEB adjudicated “chronic low back pain, status post microdiscectomy…without neurologic abnormality…” as unfitting, rated 10%.  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 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:

IPEB – Dated 20050518	VA* - (~4 Mos. Pre -Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain…Without Neurologic Abnormality	5299-5242	10%	Post Laminectomy Syndrome…	5243	10%	20050317	
			Surgical Scar, Lumbar Area	7801	0%	20050317	
			Lumbar Radiculopathy…LLE	8599-8520	0%*	20050317	
			Lumbar Radiculopathy…RLE	8599-8520	0%*	20050317	
Other x 0 (Not In Scope)	Other x 1 (Not In Scope)	
RATING:  10%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20050815 (most proximate to date of separation (DOS)).  *Increased to 10% retroactive to separation on the 20060307 VARD

ANALYSIS SUMMARY:

Chronic Low Back Pain Condition.  The CI first presented with low back pain on 14 October 2003 when she noted a 2-day history of pain without antecedent trauma.  She was treated with medications and duty limitations without resolution of her symptoms.  A magnetic resonance imaging on 11 May 2004 showed a herniated disc at L5-S1 on the right.  She had a micro-discectomy (removal of part of the disc) on 16 July 2004.  Following surgery, she had persistent pain.  Despite treatment with steroid injections, medications, and light duty, she was not able to return to full duty and was entered into the MEB process.  She noted abnormal sensation in both lower extremities.  The narrative summary (NARSUM) was dated 11 February 2005.  The CI reported that her pain was worse than prior to surgery with radiation to the (right) thigh.  On examination her gait was normal.  There was mild loss of lumbar curvature, but spasm was not recorded.  The back was tender to palpation.  She assumed a tripod stance when getting up or down from the examination table or a chair (this implies that she used her arms to assist her with position changes).  The neurological examination was normal and provocative testing for nerve root irritation was negative.  Two (of five) signs of non-organic pain were present.  The range-of-motion (ROM) was reduced and is charted below.  At the MEB examination on 24 February 2005, the CI reported numbness in both legs.  The MEB physical exam noted decreased strength at 3/5 and reduced ROM, but the examiner’s handwriting is poorly legible reducing the probative value of this examination.  Electrodiagnostic studies on 14 March 2005 were essentially negative.  

The VA Compensation and Pension (C&P) examination performed on 17 March 2005, 4 months prior to separation, was not in evidence, but was recorded in the VARD dated 15 August 2005.  The examiner noted a normal posture and gait without signs of intervertebral disc syndrome with chronic and permanent nerve root involvement.  Muscle spasm was absent.  The ROM was limited by pain and is charted below.  The neurological examination of the left lower extremity (LLE) and right lower extremity (RLE) was noted as normal.  The CI had ROM measurements on 29 April 2005 in physical therapy.  These are charted below, but are noted to be poorly legible.  The values recorded (below) were reduced for thoracolumbar ROM values; however, it is not clear if these were thoracolumbar measurements or limited to the lumbar spine.  The examiner also wrote “All goniometric motion measurements were within normal standard motion measurements for the lumbar spine.  Transitions between measurement positions were smooth and not accompanied by c/o (complaints of) pain.”  This reduces the probative value of this examination.  

The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Thoracolumbar ROM
(Degrees)	MEB ~5 Mo. Pre-Sep	VA C&P ~4 Mo. Pre-Sep	PT ~3 Mo. Pre-Sep	
Flexion (90 Normal)	70	80	40	
Combined (240)	160	230	160	
Comment	Normal neurological examination and gait	Normal neurological examination and gait	The examiner also noted that the lumbar ROM was normal and painless	
§4.71a Rating	10%	10%	20%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the back condition at 10% using the analogous code 5299-5242 (degenerative arthritis of the spine) and the code 5243 (intervertebral disc syndrome) respectively.  The ROM values recorded by the NARSUM examiner and VA C&P examiner both support a 10% rating.  The other two examinations are of reduced probative value as discussed and are, therefore, not useful for rating purposes.  The Board also noted that the VA assigned a 0% rating, each, for RLE and LLE radiculopathy (later increased to 10% each retroactive to separation based on post-separation evidence).  It considered if an unfitting radiculopathy was present at separation.  The NARSUM and C&P both documented a normal neurological examination.  The electrodiagnostic studies were normal.  Although the CI had subjective symptoms, the evidence does not support the presence of an unfitting radiculopathy at separation.  The Board concluded therefore that this condition could not be recommended for additional disability rating.  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 of the back condition.

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.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the 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.

RECOMMENDATION:  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 20140502 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, AR20150010459 (PD201401953)

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:

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

CF:
(  ) DoD PDBR
(  ) DVA