RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02439
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070517

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard, E6, Military Policeman, medically separated for back pain, with a disability rating of 10%.  

CI CONTENTION:  The CI requested that the Board review all of his conditions.  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:  

SERVICE –20070423	VARD - 20071106	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Mid and Lower Back	5299-5237	10%	L5-S1 Disc Disease…	5243	10%	20070510	
			Lumbar Facet Syndrome	5237	NSC		
RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Mid and Low Back Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition originally began early 1997 while activated for flood relief in western Kentucky.  His condition worsened in November 2005 after wrestling while on leave from his mobilization station.  Radiographic studies showed degenerative disc disease (L5-S1 mild disc bulge).  There was no surgical indication.  Despite treatment, the CI’s back condition could not be adequately rehabilitated to meet the physical requirements of his military specialty and so he was referred for a MEB.  

At the physical medicine and rehabilitation clinic examinations on 5 January and 1 February 2007, 4 months prior to separation, the examiner noted spasms in the thoracic paraspinal muscles as well as abnormal curvature of the thoracic spine.  Gait was normal and no peripheral neuropathy was noted.  ROM was noted as “normal” or “full” in each axis of movement.  

At the MEB examination (recorded on DD Form 2807 and 2808) dated March 2007, 3 months prior to separation, the CI reported chronic lower and upper back pain with numbness in upper back on left side below the shoulder.  Physical exam showed negative straight leg raise, ability to touch toes easily with waist bend, normal reflexes, and pain with dorsiflexion of the lumbosacral spine.  The MEB NARSUM exam on 19 March 2007 (3 months prior to separation) noted complaints of pain with lifting loads over 20 pounds, bending and turning his upper body, and by wearing body armor.  Physical exam documented a normal gait with tenderness and muscle spasm.  There was painful motion with ROMs charted above:  [NOTE:  VASRD spine formulae Notes 2 and 4 were applied for rounding and truncating spine ROMs].  Reflexes and neurosensory exams were normal.  

At the VA Compensation and Pension (C&P) examination on 10 May 2007, performed 7 days before separation, the CI reported pain, stiffness, and weakness in his upper and lower back with pain traveling to the left hip and knee.  Physical exam showed no evidence of radiating pain on movement.  There was painful motion.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous code 5237 (lumbosacral strain), citing tenderness and ROM “greater than 240 degrees.”  The VA also assigned a 10% rating using the 5243 code (intervertebral disc syndrome) based on the VA C&P examination 7 days before separation, citing limitation of forward flexion and limitation of combined ROM.  The Board agreed that a 10% rating, but no higher, was justified for combined ROM greater than 120 degrees but not greater than 235 degrees as reported on the NARSUM and VA exams.  Although the CI exhibited muscle spasms and abnormal contour of the thoracic spine as noted in the two physical medicine examinations, abnormal spinal contour was not noted by the MEB or VA examiners at either of the examinations which were conducted subsequent to the physical medicine examinations, thus the next higher 20% rating was not justified on this basis.  

There was no associated radiculopathy for separate peripheral nerve rating.  Although the CI experienced radiating pain, there was no objective evidence of a radiculopathy or functional impairment with a direct impact on fitness.  While the CI may have experienced radiating pain from the back condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  There is no evidence in this case that there was radiculopathy with associated functional impairments separately functionally impairing.  The Board therefore concludes 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 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.  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 20140527, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXX, AR20160007113 (PD201402439)

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