RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD -2014-02340
BRANCH OF SERVICE:  Army	Separation Date:  20060328

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Multi-System Transmission Operator) medically separated for a chronic low back (LBP) condition.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty (MOS) but an alternate physical fitness test was authorized.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The back condition, characterized as “degenerative disc disease (DDD) with mild disc bulging at L3-4, L4-5 and L5-S1 levels with lower back pain that is unresponsive to conservative measures,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “chronic LBP” as unfitting, rated 10%, citing criteria of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.  

CI CONTENTION:  The CI requests consideration of all MEB/PEB 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 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 20060214	VA* - (~10 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP	5237	10%	Intervertebral Disc Syndrome, Thoracolumbar Spine	5242	10%	20070109	
			Left Lower Extremity (LLE) … L5 Sciatica …	5243-8520	10%	20070109	
Other x 0 (Not In Scope)	Other x 3	
RATING:  10%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20070331(most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Chronic LBP Condition.  The CI had a sudden onset of LBP in December 2003 while on deployment.  The pain resolved with muscle relaxants.  In the summer of 2004 the CI developed left hip pain and left leg numbness during running and severe LBP which prevented her from walking.  Despite extensive Physical Therapy (PT) and an orthopedic evaluation, there was no improvement in the pain.  A lumbar spine x-ray performed in October 2004 was normal while a follow-on lumbar spine MRI done in August 2005 showed multi-level DDD.  The Orthopedist in October 2005, approximately 7 months prior to separation, noted a month long history of left lateral foot and calf numbness.  Exam documented tenderness of the spine, decreased motor strength (4/5) in the quadriceps (thigh) on the left side and decreased sensory in the L5-S1 distribution.  There were multiple treatment notes for radiating pain to the left leg with a diagnosis of neuritis and treatment with anti-inflammatory and narcotic medication.  

The MEB Narrative Summary (NARSUM) exam approximately 3 months prior to separation documented that the CI had a constant aching pain rated at 6-7/10 to 10/10 with incapacitation to the point where she could not get out of bed.  She reported that these episodes of incapacitation occurred once a month.  She reported that activities such as performing sit-ups, bending, negotiating stairs and lying or walking for prolonged periods.  She noted that she had difficulty sleeping at night secondary to the pain.  She reported constant left posterior thigh numbness which caused some instability with walking.  There was no report of bowel or bladder abnormality.  The MEB NARSUM physical exam findings are summarized in the chart below.  

The VA Compensation and Pension (C&P) exam approximately 10 months after separation documented that the CI had squeezing, constant aching, cramping sharp pain that radiated down to her left leg.  She rated the pain at 8/10 which was exacerbated by physical activity and relieved by rest and medication.  She reported incapacitating episodes that lasted for 2 days each month.  The VA C&P physical exam findings are summarized in the chart below.  

There were range-of-motion (ROM) evaluations in evidence, with documentation of additional ratable criteria, which the Board weighed in arriving at its rating recommendation; as summarized in the chart below.  

Thoracolumbar ROM
(Degrees)	MEB ~3 Mo. Pre-Sep	VA C&P ~10 Mo. Post-Sep	
Flexion (90 Normal)	75	70	
Combined (240)	200	210	
Comment	Inclinometer; painful motion; mild/moderate tenderness to palpation (TTP); lumbar muscle spasms; + leg raise; motor/sensory/reflexes/gait normal	Painful motion; muscle spasm; TTP; + straight left leg raise; L5 sensory deficit left dorsal foot; motor weakness left great toe extension 4/5; reflexes and gait normal	
§4.71a Rating	10%	10% 	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the back condition as 5237 (Lumbosacral strain) and rated at 10%.  The VA coded the back condition as 5242 (Degenerative arthritis of the spine) and rated at 10%.  Additionally, the VA coded the left lower extremity neurologic condition (sciatic nerve) condition as 5243 (Intervertebral disc syndrome) with 8520 (Sciatic nerve paralysis) and rated at 10%.  The “General Rating Formula for Diseases and Injuries of the Spine considers the CI’s pain symptoms “with or without symptoms such as pain (whether or not it radiates), stiffness or aching in the area of the spine affected by residuals of injury or disease.”  Both the MEB and VA C&P exams documented mild to moderate paraspinal muscle tenderness and muscle spasm; however, there was no abnormal gait or abnormal spine contour.  The CI reported periods of incapacitation; however, there was no bed rest prescribed by a physician and treatment by a physician.  The CI met the 10% spine rating criteria for limited thoracolumbar ROM (forward flexion greater than 60 degrees but not greater than 85 degrees; or, combined greater than 120 degrees but not greater than 235 degrees); or, for “muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour.”  

The pain component of a radiculopathy is subsumed under the general spine rating as specified in §4.71a.  The sensory component in this case had no functional implications.  The motor impairment was relatively minor – normal gait and motor exam at the MEB exam, VA C&P exam – slight motor weakness left great toe 4/5, with normal gait - and cannot be linked to significant physical impairment.  Since there was not sufficient evidence of functional impairment in this case, the Board cannot support a recommendation for additional rating based on peripheral nerve impairment.  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 chronic LBP condition without the addition of a neuropathy 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 chronic LBP 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 20140523 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 AR20160004387 (PD201402340)

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