RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	 CASE:  PD-2014-03397
BRANCH OF SERVICE:  Army                                                             SEPARATION DATE:  20070215

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Chemical Operations Specialist, medically separated for “chronic back pain,” 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 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:  

SERVICE PEB - 20070118	VARD - 20070905	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5299-5242	10%	Degenerative Arthritis of the Lumbar Spine	5242	10%	20070613	
RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Back Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in April 2005 after exercising.  Radiographic studies showed degenerative disc disease.  Electrodiagnostic studies (EMG/NCV), 11 May 2006, were negative for radiculopathy.  There was no surgical indication.  Despite physical therapy, epidural steroid injections, pain management, and chiropractic treatment, the CI’s back condition could not be adequately rehabilitated to meet the physical requirements of his military specialty and so he was referred for an MEB.  

The range of motion (ROM) examinations 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 ~6 Mo. Pre-Sep	MEB ~3 Mo. Pre-Sep	VA C&P ~4 Mo. Post-Sep	
Flexion (90 Normal)	Full	75	70	
Combined (240)		205	200	
Comment	Painful motion; tender	Painful motion; tender; spasm with normal gait and contour	Painful motion; tender	
§4.71a Rating	10%	10%	10%	

At the MEB examination (recorded on DD Form 2807 and 2808) dated 28 August 2006, 6 months prior to separation, the CI reported back pain with numbness and tingling.  Physical exam showed positive radicular pain symptoms in the left leg, lumbosacral spine tenderness, no muscle spasms, and full active ROM with pain as reflected in the chart above. The MEB NARSUM exam on 1 December 2006 (3 months prior to separation) noted complaints of shooting pains in his left leg.  The examiner also noted that the CI was unable to lift or carry equipment, bend, run, or perform push-ups or sit-ups.  Physical exam showed tenderness, spasms, normal motor strength with radicular pain symptoms in his left leg, normal gait, and painful limited motion as reflected in the chart above.  Reflexes, strength and sensory exams were normal.  At the time of the emergency room visit on 5 March 2007 (a month after separation), the CI reported running out of his pain medication and back pain of 10/10 with movement.  Review of systems indicated a history of weakness and numbness in his left leg.  On examination the CI was noted to have no back tenderness or spasm.  Reflexes were normal and ROM in his lower extremities was full.  

At the time of the VA primary care clinic appointment on 18 May 2007 (3 months after separation), the CI reported episodic pain radiating into his posterior thigh to his knee.  Examination tests for radicular signs were negative, and reflexes and strength were normal.  At the VA Compensation and Pension (C&P) examination on 13 June 2007, performed 4 months after separation, the CI reported low back pain that intermittently radiated down his left leg to his knee and left leg weakness.  Physical exam showed normal motor strength and reflexes in his lower extremities and painful limited motion as reflected in the chart above.  Gait was normal.  The examiner stated “there is no objective evidence of spasm or weakness on today’s exam.”  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous code 5242 (degenerative arthritis of the spine), citing pain limited motion and tenderness.  The VA also assigned a 10% rating using code 5242 based on the VA C&P examination 4 months after separation, citing limitation of forward flexion to 70 degrees.  The Board agreed that a 10% rating, but no higher, was justified for limitation of flexion greater than 60 degrees but not greater than 85 degrees or combined ROM greater than 120 degrees but not greater than 235 degrees as reported on the NARSUM and VA exams.  There was no muscle spasm or guarding severe enough to result in abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  

There was no associated radiculopathy for separate peripheral nerve rating.  Although the CI experienced radiating pain, there was no objective evidence of a radiculopathy or functional impairment with a direct impact on fitness.  While the CI may have experienced radiating pain from the back condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  There is no evidence in this case that there was radiculopathy with associated functional impairments separately functionally impairing.  The Board therefore concludes that additional disability rating was not justified on this basis.  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 20140721, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

		
SAMR-RB

28 JUL 2016

MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-00), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXX, AR20160008005 (PD201403397)

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