RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	     CASE:  PD-2014-01964
BRANCH OF SERVICE:  Army 	    SEPARATION DATE:  20080923

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, Infantry, medically separated by the Informal Physical Evaluation Board for “chronic low back pain ... degenerative disc disease [DDD] at L5-S1 without neural impingement” rated 20%.

CI CONTENTION:  The CI referenced only his back condition, elaborating current disability.  The 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 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 20080819	VA* - (10 Days Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain ... DDD	5299-5237	20%	DDD L5-S1	5243	20%	20081003	
Other x 5 (Not In Scope)	Other x 5 	
RATING:  20%	RATING:  20%	

ANALYSIS SUMMARY:   

Chronic Low Back Pain (DDD).  The service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM) documented an atraumatic onset of low back pain in May 2005 which was exacerbated by an Iraq deployment (October 2006 – November 2007).  Persistent pain without radiation or sensory symptoms was reported in March 2008 (4 months after re-deployment, 7 months pre-separation).  At that time range-of-motion (ROM) was recorded as grossly normal, and referrals for further evaluation were made.  Magnetic resonance imaging demonstrated DDD (“mild” L5/S1 without neural compromise).  The symptoms did not respond adequately to trial of conservative treatment, and surgery was not indicated.  There was a paucity of outpatient STR entries in evidence prior to MEB proceedings and the NARSUM; but, there were none which contradicted the rating evidence presented in the NARSUM, and there was no documentation of incapacitating episodes.   

The NARSUM was conducted 22 April 2008 (5 months pre-separation) and documented “day-to-day” pain rated 8/10 with exacerbations to 10/10 by driving, lifting, running, prolonged sitting, and most general soldiering requirements.  The examiner noted “occasional numbness and tingling to both feet,” but no subjective weakness.  The NARSUM physical examination recorded a normal gait, tenderness without note of spasm, and detailed normal neurological findings (5/5 strength all groups, intact sensation all dermatomes, normal reflexes).  The NARSUM examiner observed grossly decreased ROM “limited to pain” and addended physical therapy ROM measurements (goniometer with 3 repetitions) for the MEB.  These were flexion to 35 degrees (normal 90) and combined ROM of 160 degrees (normal 240).  

A VA Compensation and Pension (C&P) examination was conducted 3 October 2008 (10 days pre-separation) and documented continued pain, without elaborating severity or specifying functional limitations, and noted the absence of radiating pain, subjective weakness or sensory symptoms.  The VA physical examination recorded an antalgic gait, a normal contour, the absence of spasm or tenderness, and normal neurological findings (5/5 strength, intact sensation, normal reflexes).  The VA measured ROM was 50 degrees flexion and 170 degrees combined, specifying the absence of DeLuca degradation.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s 20% rating analogous to 5237 (lumbar strain) was consistent with VASRD §4.71a criteria for the Service ROM evidence and other ratable findings.  The VA’s equivalent rating under 5243 (intervertebral disc syndrome) was aligned with the C&P findings and ROM.  The evidence does not support any §4.71a criteria for a rating higher than 20% or the presence of incapacitating episodes that would achieve a higher rating under that formula.  The Board considered whether additional rating could be recommended under a peripheral nerve code for the reported radicular symptoms, but members agreed that neither the functional link to fitness requisite for rating nor the presence of a VASRD ratable deficit were supported by the evidence.  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 lumbar spine condition.

BOARD FINDINGS:  In the matter of the lumbar spine 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 20140429, 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 XXXXXXXXXXXXXXXXXXXX, AR20160006082 (PD201401964)

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:

Enclosure

CF:
( ) DoD PDBR
( ) DVA