RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03033
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030908

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E6, Food Service Operations, medically separated for “chronic back pain, with radiation to right hip…,” 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 based on 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 - 20030613	VARD - 20040908	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain with Radiation to Right Hip…	5293-5299-5295	10%	Degenerative Joint Disease Lumbar Spine, Status Post Right L4-5 Microdiscectomy	5242	20%	20031201	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to Service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI initially injured his back lifting a heavy pot of water approximately 5 years prior to referral for an MEB.  He reinjured his back when he slipped in the snow carrying a 75 lb. crate 6 months prior to MEB referral.  Lumbar spine diagnostic imaging (MRI) showed a mild disc bulge at L5-S1 and a large right disc protrusion at L4-5 causing central spinal canal, right lateral recess, and right neuroforaminal stenosis (narrowing).  The MEB NARSUM examination on 3 April 2003, 5 months before separation, the CI complained of lower back pain with radiation of shooting pain into the right hip.  He denied loss of bowel or bladder function.  Pain was exacerbated by activity, running, pushups, sit-ups, certain movements, and prolonged standing and not relieved massage therapy or chiropractic care.  The CI was evaluated by an orthopedic spine specialist who administered a caudal epidural steroid injection, which relieved the right leg pain.  The surgeon opined the CI may require a discectomy versus fusion.  The physical exam documented the CI was able to toe and heel walk.  The back exam revealed tenderness over the spinous process from L4 to L5.  Back range of motion (ROM) was flexion of 100, extension of 20, right lateral bending of 55, left lateral bending of 45, and bilateral rotation of 50 degrees.  Strength and deep tendon reflexes (DTRs) were normal.  Lumbosacral spine diagnostic imaging (X-ray) showed slight L4-L5 intervertebral disc space narrowing consistent with minimal degenerative change.  

At the 1 December 2003 VA Compensation and Pension (C&P) exam, 3 months after separation and 1 month before surgery, the CI complained of constant low back pain, right buttock pain, and variable radiating pain down to the right foot.  Pain was exacerbated by prolonged sitting, activity, lifting, and working.  The CI used no assistive devices and there was no physician ordered bed rest in the past year.  The physical exam documented a gait where the CI “Ambulates slowly but with no particular limp.”  The back exam revealed L5 tenderness with no scoliosis or paraspinal muscle spasm.  Pain-limited ROM was flexion of 45, extension of 20, and bilateral lateral bending of 20 degrees.  Repetitive motion did not exacerbate symptoms or change ROM due to weakness, incoordination, or fatigability.  The straight leg raise (SLR) test (assess for herniated disc causing sciatic nerve root [L5-S1] radiculopathy) was positive on the right and negative on the left.  Strength, sensation, and DTRs were normal.  Lumbar spine X-rays showed slight L4-5 and L5-S1 disc narrowing, small L4-5 osteophytes, and sclerosis of the L5 and S1 posterior elements.  Four months after separation, the CI underwent a right L4-5 microdiscectomy.  The 3-month postoperative neurosurgery follow-up documented the CI had done very well after surgery.  He denied sciatic or significant back pain.  The physical exam documented he could walk on his toes.  The back exam revealed a well healed wound with no paraspinous muscle spasm.  There was minimal limitation of ROM and the SLR test was negative.  The neurosurgeon documented “He wants to be back to his work at his full-time job without any restrictions.  I have released him to do so.”  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10% coded 5293 (intervertebral disc syndrome) and an analogous 5295 code (lumbosacral strain), citing chronic back pain with radiation to right hip due to L4-5 herniated nucleus pulposus, no neurologic abnormality, no chronic paravertebral muscle spasms, with characteristic pain on motion.  The VA rated the back condition 20% coded 5242 (degenerative arthritis of the spine) based on VA treatment reports and the VA C&P examination, 3 months after separation and a month before surgery, citing lumbar spine degenerative joint disease, status post right L4-5 microdiscectomy, no paraspinous spasm, no sciatic pain, no significant back pain, and minimal limitation of ROM.  In accordance with DoDI 6040.44, the Board is required to recommend a rating IAW the VASRD in effect at the time of separation.  The Board noted that the 2002 VASRD standards for the spine, which were in effect at the time of separation, were changed to the current §4.71a rating standards in 2004.  The Board must correlate the above clinical data with the 2002 rating schedule and applicable diagnostic codes.  The Board assigned less probative value to the NARSUM and C&P exams because they occurred before corrective surgery.  The Board assigned more probative value to the neurosurgery exam as it reflected findings after an appropriate period of postsurgical convalescence.  There was no vertebral fracture (5285), complete spine ankylosis (5286), lumbar spine ankylosis (5289), or sacro-iliac injury/weakness (5294) for consideration under the respective codes.  There was no neuropathy, characteristic pain, muscle spasm, absent DTR, neurological findings appropriate to disc site, or recurring attacks for consideration under intervertebral disc syndrome (5293).  While there were slight subjective symptoms consistent with the 0% rating, there was no characteristic pain on motion consistent with the 10% rating under lumbosacral strain (5295).  Board members agreed that the ROM values more closely approximated the slight (10%) than the moderate (20%) rating under lumbar spine limitation of motion (5292).  The Board agreed a 10% rating was supported based on VASRD §4.40 (functional loss) or §4.59 (painful motion).  
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 20140515, 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 XXXXXXXXXXXXXXXXXXXXX AR20160013895 (PD201403033)

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