RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03523
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060627

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Air Defense Tactical Operations Center Operator, medically separated for “chronic low back pain,” with a disability rating of 10%.  

CI CONTENTION:  The CI contends that he was not evaluated for his posttraumatic stress disorder (PTSD), general anxiety disorder, asthma, radiculopathy, and cervical strain 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 - 20060314	VARD - 20070226	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Degenerative Disc Disease/Degenerative Joint Disease, Lumbosacral Spine	5235-5242	10%	20070213	
			Radiculopathy, Right Lower Extremity	5242-8520	10%	20070213	
Mild Anxiety Pain Disorder	Not Unfitting 	Post-Traumatic Stress Disorder	9411	50%	20061220	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s first reported to sick call with ongoing low back pain and radicular symptoms in August 2004.  He incurred a parachute jump injury in September 2005.  Magnetic resonance imaging (MRI) studies showed mild central disc protrusion at L4-L5 with a small annular tear but no evidence of nerve root compromise, central canal stenosis, or neuroforaminal narrowing.  There was no surgical indication.  

Despite treatment, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  The MEB forwarded “chronic low back pain with lumbar neuritis with no evidence of structural disease” for PEB adjudication.  

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)	Chiro ~10 Mos. Pre-Sep	PT/MEB ~6 Mos. Pre-Sep	VA ~8 Mos. Post-Sep	
Flexion (90 Normal)	80	85	65	
Combined (240)	185	185	190	
Comments	Painful motion; tender	Painful motion; tender	Painful motion; tender; spasm with normal gait and contour	
§4.71a Rating	10%	10%	10%	

At the time of the physical therapy clinic appointment on 29 September 2005, the CI reported low back pain exacerbated since April 2005 after a fall and pain had not resolved.  The CI also reported that the pain was aggravated by standing greater than 1 hour, sit-ups, pushups, running and ruck marches.  The CI stated he had right lower extremity radicular symptoms to the distal calf.  The examiner recorded full ROM, pain on motion, tenderness, and positive provocative tests for radicular symptoms on the right lower extremity.  Strength and reflex testing were normal.  There was decreased sensation to light touch on the right in the distribution of L2, L4, L5 and S2.  

The MEB NARSUM examination on 8 February 2006 (6 months prior to separation) noted complaints of ongoing back pain.  Physical examination showed neuropathic pain with no evidence of motor dysfunction; there was normal gait, stance and reflexes without evidence of weakness in the lower extremities.  Sensory exam was intact to light touch.  There was a mildly positive right straight leg raise (for radicular symptoms) with pain from the thigh down to the foot.  There was some mild tenderness to palpation in the lower back region, no evidence of muscle wasting or weakness, clonus, or spasticity.  

At the 13 February 2007 VA Compensation and Pension (C&P) evaluation, performed 8 months after separation, the CI reported low back pain since 2004.  Physical examination showed normal posture and gait, some muscle spasms, tenderness at the L5 level, no effusion, no erythematous and no muscle atrophy.  Repetitive use showed no additional loss of motion by pain, fatigue, weakness, or lack of endurance.  Neurological exam showed decrease sensation at the medial aspect of the lower legs and the right great toe, and strength and reflexes were normal.  Lasegue sign was positive on the right for radicular symptoms.  The examiner indicated lumbar radiculopathy of the right lower extremity and that there were no periods of incapacitation in the last 12 months.  The Board noted the VA examination in August 2007, performed 13 months after separation, documented decreased back ROM (flexion to 55 degrees), increased (and bilateral) lower extremity sensory deficits with weakness, and occasional urinary incontinence.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic low back pain condition 10% coded 5237 (lumbosacral strain), citing service aggravation.  The VA rated the chronic low back pain condition 10% coded 5235-5242 (vertebral fracture/dislocation with degenerative arthritis of the spine), based on the VA C&P examination 8 months after separation, citing painful motion and limitation of motion as a result of pain.  The VA additionally rated radiculopathy, right lower extremity at 10% under code 5242-8520 (degenerative arthritis of the spine with sciatic nerve mild incomplete paralysis).  The VA increased the back rating to 20% and the right leg radiculopathy to 20% based on their examination 13 months after separation.  

The Board adjudged that the VA examination 13 months after separation was indicative of post-separation worsening and did not carry significant probative value for rating at the time of separation.  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) and/or combined ROM (greater than 120 degrees but not greater than 235 degrees) reported on the service and VA examinations proximate to separation.  Although there was muscle spasm report on the VA C&P examination, it was not severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  

The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The presence of functional impairment with a direct impact on fitness is the key determinant in the Board’s decision to recommend any condition for rating as additionally unfitting.  While the CI may have suffered additional pain from the nerve involvement, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates)” and the sensory loss did not impact duty performance.  Therefore the critical decision is whether or not there was a significant motor weakness which would impact military occupation-specific activities.  There was no evidence in this case that motor weakness existed to any degree that could be described as functionally impairing.  The Board therefore concluded that an additional disability rating was not justified on this basis.  

The Board considered whether a higher rating (§4.7) was achieved by using the alternate rating formula based on incapacitating episodes due to intervertebral disc syndrome (IVDS).  Although the CI had intervertebral disc disease there were insufficient incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of any higher rating under the alternate VASRD formula (for IVDS).  

After due deliberation, and 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.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the “mild anxiety pain disorder” condition was not unfitting.  The condition was not profiled or implicated in the commander’s statement and was not judged to fail retention standards.  The NARSUM stated that the CI “also has a mild anxiety disorder for which he is undergoing treatment with psychiatry.  This is not a limiting condition by any means and he continues to do well on Celexa 40 mg daily.”  The NARSUM diagnosis was “mild anxiety disorder which is non-disqualifying and managed well on Celexa 40 mg daily.”  The MEB was signed by a psychiatrist.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, and in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for “mild anxiety pain disorder” condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the chronic low back pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended “mild anxiety pain disorder” condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  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 20140926, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

27 JUL 2016

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 XXXXXXXXXXXXXXXXXX, AR20160011482 (PD201403523)

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.

Enclosure

CF:
( ) DoD PDBR
( ) DVA