RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03592
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080916

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Fire Support Specialist, medically separated for “chronic low back pain,” with a combined disability rating of 10%. 

CI CONTENTION:  The applicant contends PTSD and cites his back injury was wrongly diagnosed and not hereditary.  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 - 20080715	VARD – 20081202	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5237	10%	Lumbar Strain	5237	10	20081107	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:

Chronic Back Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition became symptomatic in December 2006, while deployed, after carrying a heavy combat load and getting in and out of vehicles.  His condition was later aggravated in March 2007 in a combat vehicle accident while still deployed.  Thoracic spine X-rays were normal but magnetic resonance imaging studies done in January 2008 showed Schmorl’s nodes (upward and downward protrusion of a disc into the adjacent bony vertebra) in the thoracic spine (T4 to T12).  Evaluation by orthopedics concluded with a diagnosis of symptomatic Scheuermann’s kyphosis (kyphosis [forward curvature] develops due to abnormal vertebral development during growth spurts) and indicated that there was no surgical correction for this disease.  At the time of the orthopedic examination on 21 February 2008, the CI reported that his pain increased with activity, but he had no numbness or tingling in his lower extremities.  On examination his spine showed “little to no increased curvature.”  He had full active range of motion (ROM) and there was no tenderness with palpation (TTP).  He also had normal lower extremity strength, sensation, and reflexes.  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 a MEB.  The MEB forwarded “chronic thoracic spine pain secondary to Scheuermann's kyphosis” for PEB adjudication.  

The 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 NARSUM
~3 Mo. Pre-Sep	PT MEB ~2 Mo. 
Pre-Sep 	VA C&P ~2 Mo. Post-Sep	
Flexion (90 Normal)	21	80 	90	
Combined (240)	80	165	230	
Comments	Limited motion Painful motion	Limited motion painful motion Tenderness Guarding Spasm	Limited motion Painful motion	
§4.71a Rating	10%	10%	10%	

At the physical therapy (PT) ROM examination on 22 April 2008, 5 months prior to separation, the examiner used dual inclinometers to measure the CI’s isolated thoracic spine ROM and there was no measurement of lumbar ROM.  The thoracic ROM was moderately limited and painful, with thoracic flexion of 21 degrees.  The examiner also noted that the CI had normal strength in his upper extremities and no numbness or tingling.  At the MEB examination (recorded on DD Form 2807 and 2808) dated 2 May 2008, 5 months prior to separation, the examiner indicated that the CI had a normal spinal examination.  He had “normal ROM of the spine” and no TTP. 

The MEB NARSUM examination on 8 June 2008, 3 months prior to separation, noted complaints of “daily mid back pain…with shooting pains to the right scapula intermittently.”  His pain was aggravated by activity, carrying weight on his back and performing impact exercises. On examination the CI had normal gait and spinal contour.  There was no TTP of the thoracic spine or muscle spasm.  Lower extremity strength and reflexes were normal, and examination maneuvers for radicular signs were negative.  The MEB NARSUM exam cited ROM from the PT evaluation on 22 April 2008.  PT measured ROM for the MEB a second time on 9 July 2008 as indicated in the chart above.  (Both PT ROM visits noted use of dual inclinometers and indicated ROM as thoracic ROM).  Back ROM was painful and limited.  There was no scoliotic curvature of his spine with normal lower extremity sensation and strength (limited by pain).

At the VA Compensation and Pension (C&P) examination on 7 November 2008, performed 2 months after separation, the CI reported back pain that radiated to his right foot, which did not affect his ability to walk.  The examiner recorded that there were no incapacitating episodes.  On examination the CI had normal gait.  There was no TTP or muscle spasm.  Lower extremity strength, sensation and reflexes were normal and examination maneuvers for radicular signs were negative.  There was painful ROM noted as recorded in the chart above. Thoracic and lumbar spine X-rays were normal.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10% coded 5237 (lumbosacral strain), citing forward flexion limited to 75 degrees.  The VA also rated the back condition 10% coded 5237, based on the VA C&P examination 2 months after separation, citing combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 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 and/or combined range-of-motion greater than 120 degrees but not greater than 235 degrees reported on the PT, NARSUM, and VA examinations proximate to separation.  Although there was evidence of spasm and guarding at the PT MEB ROM visit in July 2008, no abnormal gait or spinal contour was noted, and at the MEB NARSUM and C&P exams no muscle spasm was noted; thus the next higher 20% rating was not justified on this basis.  There was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula.  There was no associated radiculopathy for separate peripheral nerve rating.  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 was no objective evidence of a radiculopathy with functional impairments such as weakness with a direct impact on fitness that were separately functionally impairing for duty.  The Board therefore concluded 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 20140801, 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 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXX, AR20160008664 (PD201403592)

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