RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03072
BRANCH OF SERVICE:  Army  	SEPARATION DATE:  20070606 

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 chronic back pain, status-post L4-5 discectomy, without neurologic abnormality, rated at 10%.

CI CONTENTION:  “Please consider all conditions.”

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 20070220	VA* - (~4 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain …	5243	10%	Surgical Residuals,  L4-L5 Discectomy	5243-5237	10%	20070928	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 8 	
RATING:  10%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 2001203 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Lumbar Spine Condition.  The service treatment record (STR) corroborates the history in the MEB narrative summary (NARSUM) of an atraumatic onset of back pain with left lower extremity radiation in 2003.  Imaging demonstrated disc protrusion at L4/5 with left nerve root impingement, and the CI underwent surgery (discectomy) in November 2005 (19 months pre-separation).  There are no STR clinical notes from the post-operative period probative to rating; and, no preceding documentation of significant range-of-motion (ROM) limitations, gait disturbance, significant neurologic deficits, or periods of incapacitation after surgical recovery.

The NARSUM was conducted 10 January 2007 (5 months pre-separation) and documented “mild thoracolumbar pain which is usually associated with excessive standing or heavy lifting.”  There was no mention of concurrent radicular symptoms.  The NARSUM physical examination recorded mild tenderness, no spasm, and normal neurologic findings (5/5 strength, reflexes symmetric, sensory intact).  The NARSUM cited physical therapy ROM measurements of flexion to 80 degrees (normal 90) and combined ROM of 230 degrees (normal 240), annotating painful motion and noting normal gait and spinal contour.

A General VA Compensation and Pension (C&P) examination was conducted 28 September 2007 (4 months post-separation) and characterized the back pain as “constant with sitting and standing.”  There was no mention of concurrent radicular symptoms.  The physical examination recorded normal gait and posture, the absence of tenderness or spasm, and normal neurological findings (ROM deferred to examination which follows).  A directed Spine C&P examination followed a week later (5 October) and did not characterize pain or limitations but noted bilateral pain radiation and sensory symptoms (no weakness mentioned).  The physical examination noted a normal gait and detailed normal neurological findings.  The measured ROM was flexion to 85 degrees (DeLuca degradation to 70-80 degrees with repetitions) and combined 235 degrees.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating under code 5243 (Intervertebral disc syndrome) was compliant with criteria of VASRD §4.71a for the PEB findings and ROM evidence.  The VA’s 10% rating under 5243-5237 (Lumbar strain) was consistent with the findings and ROM evidence from both C&P examiners.  There is no ROM evidence supporting a rating higher than 10%, no evidence of gait or spinal contour abnormality in support of a 20% rating, and no documentation of incapacitating episodes which would provide for a higher rating under that formula.  The Board considered whether additional rating could be recommended under a peripheral nerve code for the radicular symptoms; but, members agreed that neither the functional link to fitness requisite for rating, nor the presence of a VASRD ratable deficit, were supported by the evidence.  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 of the lumbar spine condition.

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 lumbar spine 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 20140626, 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 AR20160005014 (PD201403072)

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