RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02154
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050930

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Satellite Communication System Operator/Maintainer, medically separated for “chronic low back pain,” with a disability rating of 10%  

CI CONTENTION:  The CI was given a higher combined rating by the VA.  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 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:    

SERVICE PEB - 20050630	VARD - 20060104	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain 	5243	10%	Degenerative Disc Disease of the Lumbar Spine	5242	10%	20050721	
			Radiculopathy, Left Leg	8599-8520	0%		
COMBIEND RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  The first record in evidence for low back pain (LBP) was a primary care note dated 27 November 2001 in which the CI reported LBP for 1 month after boxing.  His examination was unremarkable other than decreased forward flexion.  He was treated conservatively with medications and stretching.  The record then falls silent for several years until September 2003 when he was treated for LBP associated with kidney stones.  He denied a specific injury.  An X-ray on 29 September 2003 showed evidence of degenerative disc disease (DDD) and degenerative joint disease (DJD) as well as some congenital variants.  He was seen periodically over the next year for LBP.  In primary care on 13 July 2004, he had a normal gait, normal range of motion (ROM), and was without spasm.  On 13 January 2005, he reported the onset of LBP while deployed following 36 hours of taking down and setting up equipment.  He awoke with LBP and was unable to walk with pain down his left leg.  He was still on jump status, but was concerned that this could aggravate his back further.  He appeared to be in no distress.  In physical therapy (PT) several hours later, he was noted to be in some discomfort and to have very painful motion and moderately reduced forward flexion.  A chiropractic note on 1 February 2005 documented that flexion was limited and that there was LBP and left posterior thigh pain at 30 degrees.  Weakness of the left lower extremity (LLE) was observed, but his gait and stance were normal.  Sensation and reflexes were also normal.  One week later in PT, he appeared to be in discomfort, but a painful gait was not “obvious.”  Forward flexion was reduced and sensation reduced on the left in the L5-S1 dermatome.  In physical medicine on 15 February 2005, he reported LBP since heavy lifting while deployed.  Flexion was reduced to 75 degrees.  Sensation was reduced on the left in an L5 distribution.  “Normal weakness of both lower extremities was observed.”  The reflexes were normal.  Provocative testing for nerve root irritation was positive on the left.  A nerve root block was not helpful.  Neither was an epidural steroid injection (per the NARSUM).  A primary care note dated 27 April 2005 noted that the CI was not a surgical candidate.  His neurological examination and gait were noted to be normal.  Formal ROM measurements were obtained in PT on 13 May 2005 and are charted below.  An MRI on 26 May 2005 demonstrated a herniated disc at L5S1 with nerve root impingement (per the NARSUM).  The narrative summary (NARSUM) was dated 1 June 2005, 4 months prior to separation and prior to surgery (below).  Per a phone conversation, it was noted that electrodiagnostic testing had shown mild to moderate changes (presumably of the left L5S1 nerve root).  On examination, he had normal gait and posture.  He had no pinpoint tenderness and spasm was not documented.  Motor function in the lower extremities was reduced secondary to pain.  The MEB DD Form 2808, prepared the same day, recorded decreased ROM, but a normal neurological examination and negative provocative testing for nerve root irritation.  The VA Compensation and Pension (C&P) examination was performed on 21 July 2005, 2 weeks prior to surgery and 2 months before separation.  The CI reported that he could function with pain medication and had no incapacitation the prior year.  He denied lost duty time and his functional impairment was a decreased ability to bend and lift.  He was observed to be in no distress.  His gait and posture were normal and no assistive device was used.  Tenderness and spasm were absent.  No radiating pain was noted with movement.  The ROM is charted below.  Repetition increased his symptoms, but no further limitation in motion was documented.  The neurological examination was normal.  He was thought to have minimal impairment.  The CI underwent a discectomy at L5-S1 on 8 August 2005 at the VA (6 weeks prior to separation).  On 4 August 2006, the CI was seen for a VA physical examination.  He reported off and on LBP and that he took Motrin at times for “a little pain in the back.”  He was noted to be in no distress and to have no focal deficits on a neurological examination.  No specific comment was made on either gait or ROM.  A VA poly-trauma note dated 9 August 2011 recorded that he had occasional back pain which did not interfere with his daily activities.  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)	PT ~5 Mo. Pre-Sep	VA C&P ~5 Mo. Pre-Sep	
Flexion (90 Normal)	30	75	
Combined (240)	95	175	
Comment	Painful motion; Inclinometer	Painful motion; nml gait	
§4.71a Rating	40%	10%	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the back at 10%, coded 5243 (intervertebral disc syndrome) and 5242 (degenerative arthritis of the spine), respectively.  The Board noted that the MEB ROM values support a 40% rating; however, the VA values, which were all done with a goniometer and more proximate to separation, support a 10% rating.  Review of the record shows only one other value recorded for flexion, 75 degrees, in Feb 2005.  The other records in evidence a qualitative (moderate reduction, etc.) and do not provide ratable criteria.  The post-separation evidence available for review shows that the CI had minimal functional impairment from the LBP after the surgery.  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 for the LBP condition. The Board also noted that the evidence does not support the presence of an unfitting radiculopathy at separation.  

BOARD FINDINGS:  In the matter of the low back pain 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 20140514, w/atchs
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 XXXXXXXXXXXXXXXXXXXXXXX AR20160010959 (PD-201402154)

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