RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	       CASE: PD-2014-03568 
BRANCH OF SERVICE:  Army                                                                   SEPARATION DATE:  20070521

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an National Guard E3, Automated Logistics Specialist, medically separated for “chronic back pain…,” with a disability rating of 10%.   

CI CONTENTION:  The CI requested consideration of 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 based on 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 –20070419	VARD - 20070912	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5237	10%	Traumatic Arthritis, Lumbar Spine	5242	20%	20070711	
Gastroesophageal Reflux	Not Unfitting	Gastroesophageal Reflux Disease	7346	Deferred	20070711	
Adjustment Disorder	Not Unfitting	Post Traumatic Stress Disorder	9411	50%	20070812	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:   

Chronic Back Pain.   According to service treatment records, as a National Guard member the CI deployed to Iraq from July 2004 to September 2005.  In December 2004 he was involved in a HMMVV accident in Iraq.  He experienced pain and swelling in the lumbar region and was evaluated for back pain between 8 to 10 times in the clinic and prescribed medication.   X-rays in April 2006 post redeployment showed degenerative disc disease of the lumbar spine and he was treated with physical therapy.  He improved enough that he enlisted in the active Army and was required to lift and carry equipment and supplies, which worsened his low back pain and caused radicular left leg pain.  Neuroimaging showed bulging discs from L3-4 through L5-S1 in the lumbar area with nerve root involvement.  Neurosurgery considered possible surgical options but recommended none.  

At the March 2007 narrative summary (NARSUM), the CI noted he had constant pain in the back with intensity on average 7-8/10 that could become as bad as 10/10.  Lifting, running, and jumping exacerbated the pain.  He also had constant pain in the left leg ranging from 6-8/10.  He reported he was unable to place weight on the left leg and frequently awakened with left leg pain.  Low Back Pain Specialty Addendum, dated February 2007, noted the CI walked without a limp.  Exam showed that his back appeared normal without bruising or deformity with range of motion (ROM) flexion past 50 degrees (normal 90).  There was diffuse tenderness over the para spinous and lumbar muscles left greater than right, with no spine tenderness, spasm or trigger points noted.  Straight leg raising (SLR) was mildly positive at 70 degrees on the left radiating to the mid lumbar region.  Strength bilaterally was 5/5.  There was no difficulty in the heel/toe gait.  Sensation was decreased in the L5-S1 distribution of the left leg and foot with sensation otherwise intact.  The examiner noted lumbar radiculopathy without weakness in the left leg, lumbago, and mild degenerative disc disease.  Surgery was not recommended.   

NARSUM exam showed reduced ROM and pain on motion of the thoracolumbar spine.  ROM using an inclinometer showed flexion of 35 degrees (normal 90), and extension of 5 degrees (normal 30) with spasm during extension.  He could not take any event for the Army Physical Fitness Test, could not run, jump or perform impact activities.  He could lift up to 20 pounds and could stand for up to 10 minutes.  He could not wear body armor, load bearing equipment, or rucksack.   He had a sedentary lifestyle and had given up basketball and soccer.  He was working in his specialty at reduced capacity, lifting up to 20 pounds and performing administrative duties.   Prognosis for manual labor and further military service was poor.  For civilian employment prognosis was good if he could qualify to work in a sedentary position.  

At the VA Compensation and Pension (C&P) exam performed two months after separation, the CI reported sometimes he used a cane to walk but his gait was normal.  He was to begin school in August to study cosmetology.  Exam of spine showed flexion to 50 degrees, and extension to 0 degrees.  There was end of range pain and did not change with repetitive use.  There was no spasm or tenderness and SLR was negative bilaterally.  Motor strength and tone and light touch were normal in both lower extremities except some decreased light touch in the left calf.  Tendon reflexes were normal.  Flexion was to 90 degrees when removing shorts and taking off pants from the standing position.  MRI on August 2006 was normal.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% disability rating, coded 5237 (lumbosacral strain) based on pain on motion and tenderness.  The VA assigned a 20% rating, coded 5242 (degenerative arthritis of the spine) based on flexion to 55 degrees.  The Medical Evaluation Board (MEB) and C&P exams appear equidistant to the date of separation and appear to be equally probative.  The MEB examiner measured the lumbar ROM with a bubble inclinometer rather than the goniometric thoracolumbar ROM specified by the VASRD (§4.71a, Plate V).  The C&P examiner did not specify the placement of the device or whether a dual inclinometer method was used.   

The Board agreed a 20% rating was justified for the presence of forward flexion greater than 30 degrees but not greater than 60 degrees.  Board precedence requires a functional impairment linked to fitness to support a recommendation for addition of a peripheral nerve rating to Service disability in spine cases. The pain component of a radiculopathy is subsumed under the general spine rating as specified in §4.71a.  The sensory component in this case has no functional implications, and no motor weakness was in evidence.  There is thus no evidence of a separately ratable functional impairment (with fitness implications) from the residual radiculopathy; and, the Board cannot support a recommendation for an additional Service disability rating on this basis.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommended a disability rating of 20% for the chronic back pain condition.  

Contended PEB Conditions:  Gastroesophageal Reflux and Adjustment Disorder. The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the chronic back pain condition, the Board unanimously recommends a disability rating of 20%, coded 5237 IAW VASRD §4.71a.  In the matter of the adjustment disorder and GERD contended conditions, 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 recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Chronic Back Pain	5237	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140728, with attachments
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 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXX, AR20160011575 (PD201403568)

1.  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, accept the Board’s recommendation to modify the individual’s disability rating to 20% without re-characterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

			     

CF: 
(  ) DoD PDBR
(  ) DVA