RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	      CASE:  PD-2014-02643
BRANCH OF SERVICE:  Army                                                                   SEPARATION DATE:  20030429

Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Cannon Crewmember, medically separated for “chronic back pain” with a disability rating of 10%.

CI CONTENTION:  The CI makes no specific contention in his application.  His 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 - 20030401	VARD - 20030625	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain, due to Degenerative Disk Disease	5299-5295	10%	Degenerative Disc Disease with Myofascial Dysfunction and Herniated Nucleus Pulposus, Lumbar Spine	5293-5292	10%	20030327	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: 2 0%	

ANALYSIS SUMMARY:   

Chronic Back Pain Due to Degenerative Disk Disease.  The service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM) indicated the CI experienced low back pain since 1999 when an object fell on his back.  Physical therapy and chiropractic care were rendered in 2001 without significant improvement.  Pain increased in January 2002 after a motor vehicle accident.  Lumbar spine X-rays were negative and Flexeril (cyclobenzaprine, a muscle relaxer) and Feldene (piroxicam, a nonsteroidal anti-inflammatory drug (NSAID) were prescribed.  
After the motor vehicle accident the CI had neck and shoulder pain (not within the scope of the Board) in addition to the lower back pain, which was then treated with Motrin (ibuprofen, an NSAID), and Tylenol #3 (a combination of acetaminophen, a pain reliever and codeine, a narcotic), and a soft brace.  Computed axial tomography (CT scan) in March 2002 showed a herniated nucleus pulposus (HNP) with left neuroforamen (the site between vertebrae where nerves pass from the spinal cord to other parts of the body) and left nerve root encroachment in the L5-S1 intervertebral disc space.  Electrodiagnostic studies performed in April 2002 were without evidence of focal nerve entrapment in the extremities or active lumbosacral radiculopathy, either clinically or electrodiagnostically.  Examination was consistent with a lumbosacral whiplash syndrome and development of right sacroiliac malalignment and irritation.  Magnetic resonance imaging (MRI) in September 2002 showed foraminal stenosis as well as mild spinal canal stenosis, which abutted the intraspinal portion of the left S1 nerve root.  In October 2002, it was noted that the CI’s pain was refractory to chiropractic care, physical therapy, bracing modalities, nonsteroidal anti-inflammatory medications, muscle relaxers, rest, and activity modification.  The examiner indicated the CI was not a surgical candidate; and pain that originally radiated to his hips improved.  Flexion was 80 degrees and extension was 40 degrees.  Epidural and facet joint injections and symptomatic care were recommended.  X-rays of the lumbar spine in January 2003 were normal with evidence of straightening that could be due to muscle spasm.  The CI’s pain was not responsive to treatment by pain management with three injections.

At the MEB examination dated 31 January 2003, the CI reported on DD Form 2807-1, Report of Medical History, low back pain since 1999 and a back brace in 2002.  The MEB physical examiner noted on DD Form 2808, Report of Medical Examination, a full range of motion (ROM).  The commander’s statement date 20 February 2003 indicated the commander had not seen the CI perform his duties, but noted the CI had served as a driver for the unit leadership.  However, the commander did not feel the CI would be able to lift artillery rounds in excess of 95 pounds repeatedly.  An L-P3 profile was issued on 21 February 2003 with limitations of no wearing a backpack, no running, no jumping, no marching, no flutter kicks, no crawling, no stooping, no bending, no sit-ups, no pushups, and no prolonged standing.

The NARSUM dated 3 March 2003 indicated the CI used Duragesic patches (fentanyl, an opioid/narcotic pain medication) for pain relief and Dantrium (dantrolene, a muscle relaxant).  On examination the CI had a negative straight leg raise bilaterally (to determine nerve root irritation).  Neurological examination was unremarkable.  There was a full range of motion (ROM) of the back and forward flexion to greater than 90 degrees, and there was mild L4, L5, and S1 paraspinous tenderness to palpation bilaterally.

At the VA Compensation and Pension (C&P) examination dated 27 March 2003, performed 1 month before separation, the CI reported a 50 caliber rack fell on his back and in January 2002, that he was involved in a motor vehicle accident; and that standing for long periods of time caused pain in his low back area.  On examination the CI’s posture and gait were within normal limits.  There were no complaints of radiating pain on movement.  No muscle spasm or tenderness was noted.  Straight leg raising was negative bilaterally.  There were signs of radiculopathy on the right side with subjective factors of reports of occasional episodes of burning sensation to the buttock and with objective factors of no clinical evidence of sensory dysfunction.  The ROMs are in the chart below.  The ROM of the spine was additionally limited by pain.  There was no ankylosis. 

The 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)	MEB ~2 Mo. Pre-Sep
	VA C&P ~1 Mo. Pre-Sep
	
Flexion (90 Normal)	> 90	(85)86	
Extension (30)		30	
R Lat Flexion (30)		30	
L Lat Flexion (30)		(30)34	
R Rotation (30)		(30)35	
L Rotation (30)		(30)35	
Combined (240)	-	235	
Comment	Paraspinous tenderness to palpation bilaterally	Pain at the end of motion	
§4.71a Rating	PEB 10%	VA 10#%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating using code 5299-5295 (lumbosacral strain with characteristic pain on motion) for chronic back pain due to degenerative disk disease without neurologic abnormality or documented chronic paravertebral muscle spasms.  The VA assigned a 10% rating using code 5293-5292 (intervertebral disc syndrome-spine limitation of motion, lumbar-slight) for degenerative disc disease with myofascial dysfunction and HNP.  The Board sought a route to a higher rating; however, in the absence of ankylosis, muscle spasm on extreme forward bending, or moderate, recurring attacks with persistent symptoms compatible with sciatic neuropathy with characteristic pain and demonstrable muscle spasm, or any episodes of incapacitation.  The Board then considered whether an additional Service rating could be recommended under a peripheral nerve code.  Although intervertebral disc disease with herniation was demonstrated on an MRI, there were no symptoms or objective findings of radiculopathy to support a rating higher than 10% under this code; and there was no evidence of a separately unfitting or ratable peripheral nerve impairment due to radiculopathy.  Therefore, radiculopathy could not be recommended for an additional disability rating.  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  back pain due to degenerative disc disease condition.  

BOARD FINDINGS:  In the matter of the chronic back pain due to degenerative disc disease 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 20140524, with attachments
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 AR2016001 0957 (PD201402643)

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