RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02750
BRANCH OF SERVICE:  Army  	                        SEPARATION DATE:  20080616

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Infantry, medically separated for “chronic low back pain,” with a disability rating of 20%.  

CI CONTENTION:  The applicant makes no specific contention in his application.  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 - 20080424	VARD - 20061021	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5237	20%	Low Back Pain w/Degenerative Process…	5237	10%	STRs	
RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), 2 months prior to separation, the CI’s back condition began in April 2006 while deployed to Iraq, noting no specific injury.  The CI was a Stryker driver and noted that many times a day he would have to jump off the driver’s platform approximately 5 feet off the ground.  Radiographic studies showed some degenerative change at L5 and mild multilevel spondylosis.  Physical therapy did not provide significant improvement, but medication did, to a large degree, control his pain.  Some radiation down the right leg was noted; however, it was intermittent.  The NARSUM examination noted normal gait and stance, negative straight leg raising (for radicular symptoms), that the CI moved about the exam room without difficulty, and that functional status was deemed greater than indicated by pain during the examination.  Range of motion (ROM) measurements are charted below.  

The CI did not attend his VA Compensation and Pension (C&P) exam, scheduled 2 months after separation.  At the VA C&P examination on 8 December 2008, performed 6 months after separation, the CI reported progression of back stiffness and pain with pain radiation down his right leg with flares up to 9/10.  Physical exam showed limited ROM as charted below with pain after repetitive motion.  

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 Exam ~3 Mo. Pre-Sep	PT ~3 Mo. Pre-Sep	NARSUM ~3 Mo. Pre-Sep	Addendum ~3 Mo. Pre-Sep	VA C&P ~6 Mo. Post-Sep	
Flexion (90 Normal)	90	55 	90	85	80	
Combined (240)	>120; <235	125	220	>120; <235	215	
Comment:  VASRD spine notes 2 and 4 applied	Pain	Pain, spasm, guarding, antalgic gait	Pain, no spasm or guarding	Pain, normal gait	Pain, spasm, normal gait, lumbar flattening, +test for radiating signs	
§4.71a Rating	10%	20%	10%	10%	10%-20% (VA 10%)	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating under code 5237 (lumbosacral strain), citing loss of flexion and combined ROM to 129 degrees.  The VA assigned a 10% rating using the same code as the PEB, citing the MEB limited ROMs for their rating and did not change their rating after the 6 month post-separation VA exam.  The PEB had two sets of ROM data that could have been used to make their decision.  They chose to use the data set obtained from a civilian physical therapist 3 months prior to separation vice the NARSUM data set obtained 2 months prior to separation which would have resulted in a 10% rating.  The civilian data set was verified by an Army physician who stated that the results were likely correct as the CI was having a “bad day.”  The Board therefore agreed that the 20% rating, and no higher, was justified.  

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 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 20140528, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander, US Army Physical Disability Agency (AHRC-00), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for AR20160007640 (PD201402750)

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