RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX                                                                        CASE:  PD-2014-02248
BRANCH OF SERVICE:  Army                                                                  SEPARATION DATE:  20071127	

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Automated Logistics Specialist, medically separated for “lumbosacral strain,” with a disability rating of 10%.

CI CONTENTION:  The CI has asked for consideration of 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 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 - 20071031	VARD - 20080301	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbosacral Strain	5237	10%	DDD, Lumbar Spine	5242	0%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Lumbosacral Strain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back pain (LBP) began in 2005 after participating in a two-man carry during Advanced Individual Training.  At the initial evaluation on 2 September 2005 he had a normal range of motion (ROM) and gait.  Two months later, the CI was again evaluated in primary care and had normal ROM with a normal neurological examination.  He reported that his LBP began after he and 4 others moved a 3,000 pound safe.  X-rays that day showed minimal degenerative disc disease (DDD) at L4-5.  The CI was seen multiple times and consistently had normal ROM until a primary care visit on 8 May 2006 when it was noted to be limited.  Three months later on 2 August 2006, the CI again had normal ROM and loss of sensation over the left>right leg and loss of a patellar reflex on the right.  Repeat X-rays on 8 August 2006 showed minimal degenerative joint disease.  The same day, radiographic magnetic resonance imaging showed no evidence of a disc herniation or central or lateral stenosis.  The CI was seen in neurosurgery the next day.  He was noted to have a slight reduction in flexion on examination, but was able to bend forward to take off his sandals and get on and off the examination table without difficulty.  Motor function was normal, but sensation reduced in the right leg in a non-dermatomal (non-nerve root) pattern.  The reflexes and gait were normal.  Electrodiagnostic testing (not in evidence) was recorded as suggestive of a right motor neuropathy (non-nerve root).  However, a subsequent test on 1 February 2007 was normal.  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 a MEB.  The MEB forwarded “lumbago” for PEB adjudication.  A family practice note dated 12 July 2007 recorded painful, but full ROM with a normal gait and stance.  Reflexes were normal as well.  

In orthopedics on 8 August 2007, the neurological examination, gait, and ROM were normal.  Painful motion was not documented.  Tenderness and spasm were absent.  At an orthopedic follow-up on 7 September 2007, the examination remained normal.  Formal ROM measurements were obtained in physical therapy (PT) on 2 October 2007.  These were accomplished with an inclinometer and showed flexion of 25 degrees (normal 90) and a combined ROM of 140 (normal 240).  The NARSUM, dated 15 October 2007, indicated the CI reported recurring back pain that occasionally led to incapacitation for short periods of time, occasional paresthesias, no history of radicular pair or weakness, and no bowel or bladder dysfunction.  On examination, there was no evidence of abnormal curvature.  The CI was in no distress.  The gait was normal.  There was some mild muscle tenderness, but no spasm.  Motor strength was 5/5 and straight leg-raising was negative.  The ROM was not recorded.  

The CI failed to report for his VA Compensation and Pension (C&P) examination in January 2008.  However, a C&P examination on 25 January 2010, 26 months after separation and outside the normal 12 month window for higher probative value, showed a flexion of 70 degrees with a combined ROM of 210.  Painful motion was present, but the gait and posture normal.  Sensory changes were present.  At a neurology evaluation in 2014, which noted the (long-standing) physical findings in the right leg, the CI was determined to have a femoral nerve injury.  

The Board directed attention to the rating.  PEB assigned a 10% rating under the 5237 code (lumbosacral strain), citing tenderness to palpation. The VA assigned a 0% rating using the 5242 code (degenerative arthritis of the spine) as the CI failed to report for his VA C&P examination.  The Board discussed the fact that the only formal ROM measurements in evidence were taken with an inclinometer.  While they rate at 40%, they are an outlier from numerous other notes in the service record as well as post-separation evidence.  The PT exam noted spasm, guarding, abnormal gait, and abnormal spinal contour; however, the NARSUM, written 2 weeks after the PT ROM exam, did not note any of those conditions.  The preponderance of evidence recorded a normal or near normal ROM.  Pain and tenderness to palpation was noted on the NARSUM, the examination most proximate to separation; these support a 10% rating.  

The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI reported intermittent paresthesia; however the electro-diagnostic studies showed no evidence of neuropathy or radiculopathy.  The presence of functional impairment with a direct impact on fitness is the key determinant in the Board’s decision to recommend any condition for rating as additionally unfitting.  While the CI may have suffered additional pain from the nerve involvement, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  Therefore the critical decision is whether or not there was a significant motor weakness which would impact military occupation specific activities.  There is no evidence in this case that motor weakness existed to any degree that could be described as functionally impairing.  In addition, post–separation evidence indicated that there was a peripheral nerve injury on the right side rather than a neurological loss from the back condition.  The Board therefore concluded that additional disability rating was not justified on this basis.  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 back condition.  

BOARD FINDINGS:  In the matter of the lumbosacral 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 20140415, 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, AR20160007487 (PD201402248)

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