RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02909
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050314

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Infantryman) medically separated for low back pain (LBP), rated at 10%.  

CI CONTENTION:  The applicant 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 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 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: 

IPEB – Dated 20050105	VA* - (~5 Days Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain with L5/S1 Discectomy and Recurrent L5/S1 Herniated Disc	5237	10%	Residuals, L5-S1 Diskectomy	5243	10%	20050309	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 8 (equals SC, NSC & deferred)	
RATING:  10%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20050412most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Low Back Condition.  While loading a truck, the CI heard a ‘pop’ and immediately experienced LBP in January 2000.  A magnetic resonance image (MRI) revealed a herniated disc at the lumbosacral junction.  On 13 October 2000, he underwent a partial discectomy of L5-S1 vertebrae.  Postoperatively, he recovered well enough to deploy.  In late 2003, his back pain with radicular symptoms into his left leg returned and additional radiographs indicated another disc herniation at L4-L5 spinal level.  His remaining mainstay of treatment was pain management and included injections as well as physical therapy (PT).  In October 2004, he was permanently profiled and referred to an MEB.  At the MEB narrative summary (NARSUM) examination (1 December 2004; 4 months prior to separation), the CI reported LBP with extension into both legs.  The physical examination (PE) revealed lumbar spine tenderness.  Thoracolumbar range-of-motion (ROM) was decreased and painful.  Distal motor and strength tests were intact.  The diagnosis was listed as chronic LBP with herniated L5-S1 disc status post previous lumbar discectomy.  At the VA Compensation and Pension (C&P) examination (9 March 2005; a week prior to separation), the CI endorsed continued LBP.  His PE revealed lumbar spasms and a normal gait.  Thoracolumbar ROM was decreased.  There was no comment in regards to the presence of painful motion.  The goniometric 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 ~4 Mo. Pre-Sep
(20041201) 	VA C&P ~1 week Pre-Sep
(20050309) 	
Flexion (90 Normal)	70	85	
Extension (30)	5	5	
R Lat Flexion (30)	20	20	
L Lat Flexion (30)	20	20	
R Rotation (30)	-	25	
L Rotation (30)	-	25	
Combined (240)	-	180	
Comment	tenderness; painful motion	spasm; (+) normal gait	
§4.71a Rating	10%	10%	

The Board directed its attention to its rating recommendation based on the above evidence.  Both the PEB and VA rated 10% under slightly different VASRD codes of 5237 (lumbosacral strain) and 5243 (intervertebral disc syndrome), respectively.  Board members agreed that sufficient evidence of persistent painful motion was present to justify the Service’s 10% rating IAW §4.59.  Compensable ROM parameters as well as other clinical criteria also supported 10%.  There were no available alternative or analogous coding options which were applicable and or advantageous to the CI’s current 10% rating.  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 10% for the LBP condition was appropriately recommended in this case.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the low 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 20140603, 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 AR20160004504  (PD201402909)

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 
( ) OVA