RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03310
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20031216

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve CW2 (Radar Targeting Officer) medically separated for chronic low back pain (LBP).  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  The profile allows for an alternate aerobic event to satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “chronic lumbago with left leg sciatic symptoms, residual, status post L5-S1 diskectomy and instrumentation” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic low back pain with left lower extremity radiation, status post L5-S1 fusion, without significant neurologic abnormality”as unfitting, rated 10% with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.  

CI CONTENTION:  “Please consider all conditions.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2).  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/Naval 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 20031015	VA* - (~2 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain…	5241	10%	S/P Thoracolumbar Spine Fusion	5241	10%	20031014	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 11	
RATING:  10%	RATING:  70%	
*Derived from VA Rating Decision (VARD) dated 20040116 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Chronic Low Back Pain… Condition.  The record showed that the CI was evaluated for a partial tear of a right calf muscle in the fall of 2002 which occurred running.  He was subsequently found to have back pain suspicious for a disc injury.  He reported a parachute jump injury 3 years earlier as documented on an X-ray request.  No contemporaneous records for this event were found in the evidence available for review.  The lumbar spine X-ray showed spina bifida occulta (an incomplete closure of the backbone [vertebrae], a congenital condition), but no definite fracture.  The next day in primary care, he reported that he had a (partial) parachute collapse a few years earlier and fell 60 feet.  His symptoms had waxed and waned with activity.  He was evaluated in physical therapy (PT) on 22 November 2002 and noted to have a non-antalgic gait (to not guard against pain; this is normal) and reported numbness in both lower extremities (BLE).  He reported in primary care that day that in 1997 someone had stolen the air from his parachute and that he then fell approximately 60 feet.  An MRI on 3 December 2002 documented mild degenerative disc disease (DDD) at L4-5 and L5-S1 along with some bony degeneration (foraminal stenosis); no compromise of either the spinal cord or nerve roots was present; however, these views of the transverse processes (the side bones of the vertebral bodies) were later noted to not be adequate to exclude a transverse process fracture.  He was given duty limitations with some improvement in his pain.  At a 2 January 2003 follow up in primary care, he reported continued decreased sensation of the left leg as well scrotal and foot numbness.  On examination, his gait and posture were normal as was the neurological examination other than some decrease in sensation in an L5 distribution (side not specified).  He was treated in PT without resolution of his symptoms.  He was evaluated in neurosurgery on 11 February 2003 and noted to have decreased sensation in a right L5 distribution.  Provocative testing for nerve root irritation was positive on the right.  The previously noted foraminal stenosis was thought to possibly cause his symptoms.  Electrodiagnostic studies were normal.  A dye study (lumbar myelogram) on 3 March 2003 showed “minimal impression on the dural sac at the L3-4 and L4-5 levels…”  The neurosurgeon did not think that this explained the CI’s symptoms.  He was also thought to have a fracture secondary to the parachute accident noted above.  This was confirmed at surgery on 4 April 2003 and the CI also underwent removal of bone overlying the symptomatic nerves and fusion at L5-S1.  At a neurosurgery follow-up on 13 April 2003, he was noted to have improving strength and normal motor and sensory function.  However, in PT on 6 May 2003, he reported numbness on the left and right (not well specified).  

The narrative summary (NARSUM) was dated 26 August 2003, less than 4 months prior to separation, and incorporated the MEB history and examination.  It recorded the onset of LBP after a parachute accident in 1999 with a free fall of 60 at Ft Bragg, NC.  The neurological examination was normal other than increased reflexes of the left knee and ankle.  The commander noted 2 days later that the CI could not ride in tactical vehicles more than 30 minutes without a 10 minute break.  Also, he could not bend or stand for prolonged periods of time.  No comment was made on any duty impairment from the sensory complaints.  

At the VA Compensation and Pension (C&P) examination performed 2 months prior to separation; the CI reported numbness in the legs and scrotum.  He reported that he was unable to walk, climb stairs, shop, garden, or push a lawnmower.  He had a normal posture and gait.  The ROM was reduced as charted below.  On examination, an L5 radiculopathy was present bilaterally.  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	VA C&P ~2 Mo. Pre-Sep	
Flexion (90 Normal)	75	80	
Combined (240)	205	230	
Comment	Inc ankle reflex on Left	Bil L5 sensory loss	
§4.71a Rating	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA rated the chronic low back pain at 10%, coded 5241 (spinal fusion).  The VA also rated the CI for left and right leg, radiculopathy, coded 5241-8520 (moderate incomplete paralysis of the sciatic nerve).  The Board first considered the rating for the back.  The ROM on both examinations supports no more than a 10% rating.  Spasm was not documented and the gait and posture were normal on the VA examination.  The Board found no route to a rating higher than the 10% adjudicated by both the PEB and VA.  The Board then considered if an unfitting radiculopathy was present at separation.  It noted that the NARSUM examination was normal, the commander made no comment on this condition, and that it was not profiled.  There is no indication in the record that the CI was limited in his duty other than by the back pain.  The PEB specifically noted that there was no significant neurological deficit.  The evidence does not support the presence of an unfitting radiculopathy at separation.  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:  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 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.  

RECOMMENDATION:  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 20140606, 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 AR20160004517 (PD201403310)

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