RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	     CASE:  PD-2014-02903
BRANCH OF SERVICE:  Army	                             SEPARATION DATE:  20050614

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

CI CONTENTION:  “Please consider all conditions.”  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 –20050211	VARD - 20050621	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5237	10%	Degenerative Joint Disease, Lumbar Spine	5242	0%	20050316	
RATING:  10%	RATING:  30%	

ANALYSIS SUMMARY:

Chronic Low Back Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back pain condition began in October 2000 while running.  The CI denied any specific injury or trauma.  Radiographic studies showed mild to moderates degenerative joint disease (right paracentral disc protrusion with spinal foraminal compression in the lumbar spine).  There was no surgical indication.  Despite treatment, the CI’s back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and was referred for an MEB.  The MEB NARSUM exam on 6 December 2004 (6 months prior to separation) noted complaints of low back pain only during running.  Physical exam showed the CI’s gait was normal, a positive straight leg raise (SLR-for radicular symptoms) on the left, deep tendon reflexes were +2 (normal), no motor weakness, normal muscle strength (5/5), sensory intact and Waddell’s (non-physiologic findings) negative.  The physical therapy exam on 13 December 2004 indicated the range of motion (ROM) as forward flexion on three repetitions of “60, 65, 66” degrees (normal 90) with a combined ROM of greater than 200 degrees but not greater than 235 degrees (normal 240).  

At the VA Compensation and Pension (C&P) examination on 16 March 2005, performed 3 months before separation, the CI reported lower back pain 7/10 for 4 years which he described as sharp, aching and which radiated to his upper back.  Physical exam showed a pain limited ROM of forward flexion of 70 degrees with a combined ROM of 220 degrees.  After repetitive use there was additional pain as a functional impact.  The gait was within normal limits.  There were no complaints of radiating pain on movement.  There was no muscle spasm or tenderness.  The neurological exam revealed motor and sensory functions were within normal limits.  There was a negative SLR bilaterally.  The radiological consult indicated a normal thoracolumbar spine.  The 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 ~6 Mos. Pre-Sep	VA ~3 Mos. Pre-Sep	
Flexion (90 Normal)	65 (60/65/66)	70	
Comment:	See text	Pain limited motion	
§4.71a Rating	10%-20% (see text)	10% (VA 0%)	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous code 5299-5237 (lumbosacral strain), citing limitation of motion due to pain (flexion of 88 degrees was a passive ROM value).  The VA assigned a 0% rating using code 5242 (degenerative arthritis of the spine) indicating that the CI did not meet the 10% rating criteria, but also citing the evidence of the VA C&P examination 3 months before separation.  

The Board discussed the rating level of the PT exam for forward flexion as there was a judgment between the forward flexion 65 degrees value versus a possible 60 degrees rating value which would rate at 20% and 10% respectively.  However, the Board adjudged that the VA exam had the highest probative value for rating as it was closest to and prior to separation.  The Board agreed a 10% rating was justified for the presence of pain limited motion by either forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, 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 documentation of incapacitating episodes which would provide for a higher rating under that formula.  

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 chronic low back pain condition.  

BOARD FINDINGS:  In the matter of the chronic 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 20140611, 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 AR20160007946 (PD201402903)

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