RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02820
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070627

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

CI CONTENTION:  The CI contends he was given a higher rating by the VA.  He was not evaluated for PTSD.  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 – 20070515	VARD - 20071023	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain Without Neurologic Abnormality	5299-5237	10%	Degenerative Disc Disease, L5-S1, Lumbar Spine	5242	20%	20070822	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic Back Pain without Neurologic Abnormality.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic back pain condition began in April 2006 after falling from the second floor onto a concrete floor.  Subsequent radiographic studies showed minimal (10%) anterior compression fracture of the T11 vertebral body, and small disc protrusions between T5-10.  Lumbar imaging was normal, and there was no surgical indication.  Despite treatment, ongoing back pain with radiation to the legs could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and he was referred for an MEB.  The MEB forwarded “lumbago” for PEB adjudication.
 
At a pain management appointment on 18 July 2006 (11 months prior to separation) the CI reported constant throbbing bilateral lower back pain that was worse with standing, walking and bending.  Physical examination showed bilateral lumbar spine tenderness, painful flexion, a normal gait and 5/5 strength of the lower extremities.  Examination by an orthopedist on 21 July 2006 showed normal thoracolumbar motion in all planes, but measurements were not provided.  Tenderness was present, and spasm was absent.

At the MEB examination (recorded on DD Forms 2807 and 2808) on 26 April 2007 (2 months prior to separation) the CI reported tingling in his left leg.  Physical examination showed lower thoracic spine tenderness.  A test for nerve root irritation was negative.  At the NARSUM exam on 26 April 2007 the CI reported constant pain of 4/10 severity that increased to 8/10 with certain activities.  Due to his condition, he noted difficulty sleeping, and he no longer participated in weight lifting, boxing, martial arts or dancing.  Physical examination observed him to not sit in one place during the interview.  Paraspinal tenderness was present, and testing for nerve root irritation was negative.

At the VA Compensation and Pension (C&P) examination on 22 August 2007 (2 months after separation) the CI reported constant pain characterized as squeezing, aching, sharp and stabbing in nature, with severity rated at 8/10.  He reported the ability to vacuum, walk and drive a car, but could not perform gardening, climb stairs or push a lawn mower.  He was currently employed as a diesel mechanic.  The pain was worsened by prolonged standing or sitting or physical activity and stress.  At the time of the examination there was no evidence of radiating pain on movement.  Spinal curves and gait were normal and no assistive devices were required.  Muscle spasms were absent but tenderness was present.  Testing for nerve root irritation was negative, and lower extremity neurologic findings were normal.

The range of motion (ROM) examinations 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)	PT ~9 Mos. Pre-Sep	MEB/PT ~2 Mos. Pre-Sep	VA C&P ~2 Mos. Post-Sep	
Flexion (90 Normal)	30	30,30,30	65	
Combined (240)	Not performed	150	215	
Comment	Gait and lumbar curve normal	Inclinometer used for forward flexion, extension and lateral flexion; +painful motion	+Tenderness, painful motion; no additional loss after repetitions	
§4.71a Rating	40%	40%*	10% (VA 20%)	
	*Conceding accurate correlation of inclinometer with goniometer to measure flexion

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the analogous 5237 code (lumbosacral strain), citing thoracolumbar motion limited by pain (likely application of AR 635-40) with spasm and localized tenderness.  The VA assigned a 20% rating using the 5242 code (degenerative arthritis) based on the VA C&P examination 2 months after separation, citing flexion of 65 degrees with pain occurring at 55 degrees, but specifically noted the ROM was “additionally limited by 0 degrees after repetitive use.”  The Board noted the disparity between the examinations depicted above and carefully reviewed the evidence proximate to separation, and the totality of the record to determine the probative value of each examination.  The following issues were considered: (1) the first PT exam was 5 months after the injury (which included a vertebral compression fracture) and 9 months before separation.  Subsequent examinations were therefore more reflective of a healed state and more probative to the date of separation; (2) the PT ROM measurements 2 months prior to separation were taken with an inclinometer, which do not correlate well with measurements derived from the VASRD-required goniometer; (3) the C&P examination 2 months after separation was complete and used a goniometer.  The Board therefore assigned preponderant probative value to the VA C&P examination for its recommendation.  ROM measurements from that evaluation supported a 10% rating (for flexion greater than 60 degrees but not greater than 85 degrees, and combined ROM greater than 120 degrees but not greater than 235 degrees).  There was no muscle spasm or guarding severe enough to result in abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no evidence of intervertebral disc syndrome (IVDS) which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula (for IVDS).  There was also no evidence of an associated unfitting radiculopathy for consideration of a separate peripheral nerve 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 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 20140602, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for AR20160007939 (PD201402820)

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