RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03149
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20030323

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Supply Specialist) medically separated for chronic low back pain, rated at 10%.

CI CONTENTION:  The applicant has asked for consideration of all conditions 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 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:  

IPEB – Dated 20021125	VA* -  based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5295	10%	Degenerative Disc Disease	5243	10%	STR	
			Impotence secondary to Back	7599-7522	NSC	STR	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 2 (equals SC, NSC & deferred)	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20120816 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  The CI’s date of separation was 23 March 2003.  The VA rules for rating the spine were changed to the current rules with an effective date of 26 September 2003. However, the Board must make its rating recommendation based upon the VASRD rules in effect on the date of separation IAW DoDI 6040.44.  

Chronic Low Back Pain.  The narrative summary (NARSUM) noted the CI developed low back pain (LBP) with radiation down the left lower extremity (LLE), without specific trauma.  Lumbar spine X-rays on 23 May 2001 were normal.  Computed tomography (CT) of the abdomen and pelvis and lumbar magnetic resonance imaging (MRI) noted an L4-5 disc bulge, with encroachment on the bilateral neural foramen.  At a neurosurgery consult on 17 September 2001, the CI reported LBP with LLE pain and numbness/tingling (N/T).  The exam noted normal lower extremity (LE) strength, sensation, and reflexes and straight leg raise (SLR) testing was positive on the left.  Surgical options were discussed, but the CI opted for continued conservative treatment and an MEB was initiated.  In a memorandum to the MEB dated 13 March 2002 the CI indicated he had changed his mind and requested to have surgery due to his pain.  At a second civilian neurosurgery consultation on 24 April 2002, the CI reported chronic low back and LLE pain.  The physical exam noted full lumbar spine motion, with normal SLR testing and normal exam of the bilateral LEs.  The neurosurgery examiner ordered a new lumbar MRI, which showed the same findings noted on the previous MRI, with nerve irritation at L4-5 bilaterally and also degenerative disc disease at L5-SI without nerve impingement or spinal canal stenosis.  

At the MEB exam on 11 September 2002, 5 months before separation, the CI reported LBP with radiculopathy.  The MEB physical exam noted back ROM of fingertips 20 centimeters from the floor, “which produces angle of approximately 80 degrees” and lateral bending “brings fingertip to the fibular heads right and left.  This produces an angle of approximately 45 degrees.”  The CI was able to heel and toe walk without difficulty.  Lower extremity strength and reflexes were normal, with negative SLR bilaterally.  There was “minimal to no…muscle spasm” on exam.

There was no VA Compensation and Pension (C&P) exam performed within 12 months of separation.  

The Board directed its attention to its rating recommendation based on the above evidence.  
The PEB rated 10%, coded 5299-5295 (lumbosacral strain) for the low back condition.  The original VA Rating Decision was dated 16 August 2012 and noted a 10% rating for the low back condition, coded 5243.  The Board notes that the VARD in record was too remote from the CI’s date of separation to have probative value with regard to the its rating recommendation for the disability due to the low back condition at the time of separation.  The Board noted that the MEB exam ROM was described as near normal thoracolumbar ROM and normal lateral flexion bilaterally.  Members agreed that the evidence in record supports a 10% rating coded as 5295, based upon lumbosacral strain with “characteristic pain on motion” and did not meet the next higher evaluation of 20%, which specifies “with muscle spasm on extreme forward bending” or “loss of lateral spine motion in standing position.”  The Board reviewed to see if coding as 5293 (intervertebral disc syndrome) resulted in a higher rating based on incapacitating episodes, defined by the VASRD as a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician.  However, there were no incapacitating episodes as defined documented in record.  The VASRD in effect on the date of separation notes that intervertebral disc syndrome may be alternatively rated based on ‘‘chronic orthopedic and neurologic manifestations’’, defined as “orthopedic and neurologic signs and symptoms resulting from intervertebral disc syndrome that are present constantly, or nearly so.”  In this case, the separate orthopedic and neurologic disabilities are to be evaluated under the most appropriate orthopedic and/or neurologic codes and combined IAW VARSD §4.25.  Members agreed that the CI had back pain with motion as noted above which warrants a 10% rating coded as 5295, and the Board noted that the CI reported chronic LLE pain with intermittent numbness.  At the MEB exam bilateral SLR was negative and there was no reported radiating pain with any movements.  At the NS consult after the MEB, the CI had a completely normal exam of the back and LEs, without evidence of a radiculopathy.  The Board agreed that proximate to separation the evidence supports the CI’s radiating pain and N/T of the LLE was improved.  The Board concluded that there was insufficient evidence in record of functional impairment related to the neurologic symptoms to recommend a rating for a chronic neurologic disability.  Therefore, the Board determined that evidence supports a 10% rating for the low back condition and no higher.  After due deliberation in consideration of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the low back condition.  

BOARD FINDINGS:  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 20140630, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						
MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite XXX, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXX, AR20160004074 (PD201403149)

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: