RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03749
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060717

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Wheeled Vehicle Mechanic, medically separated for “chronic low back pain” and “radiculopathy, right S1” rated 10% and 10% respectively, with a combined disability rating of 20%.

CI CONTENTION:  The CI contended multiple conditions that were not identified by the MEB or PEB.  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 upon a 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 - 20060412	VARD – 20060721	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5243	10%	DDD, L5-S1, Lumbar Spine	5243	10%	20060228	
Radiculopathy, Right S1	8520	10%	Radiculopathy, Right Lower Extremity	5252	0%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Low Back Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in 2002 after he fell off a truck and landed on his tail bone.  Initial radiographic imaging was normal but later imaging, more proximate to separation, revealed a bulging disk at L5-S1 and nerve root narrowing at S1.  Despite non-surgical treatment and pain management therapy the condition could not be rehabilitated to meet the physical requirements of the CI’s military specialty and he was referred to an MEB. 

The MEB forwarded “chronic low back pain (LBP) with nerve root displacement” to the PEB for adjudication.

During the MEB NARSUM in August 2005, 11 months before separation, the CI reported LBP that was aggravated with running and lifting.  His physical examination (PE) revealed tenderness about the low back.  The range of motion (ROM) examination was performed by physical therapy in June 2005, 14 months before separation, noting decreased motion in all directions with a combined range of 155 degrees; flexion was 50 degrees (normal 90).  At the VA Compensation and Pension (C&P) examination in February 2006, 5 months before separation, the CI reported LBP with numbness down his right leg aggravated by exercise, prolonged standing/sitting, walking, or bending.  Worsening flare-ups occurred weekly and lasted 3 hours.  His PE revealed the use of a cane for ambulation.  The spine focused PE was normal except for globally decreased low back ROM with a combined measurement of 160 and flexion to 70 degrees.   

The Board directed attention to its rating recommendation based on the above evidence.  Both the PEB and VA rated the low back condition at 10% using VASRD code 5243 (intervertebral disc syndrome), citing painful motion/tenderness and limitation of motion, respectively.  The Board first agreed that the VA examination was most probative due to its close time reference to separation.  The measured flexion of 70 degrees as well as the 160 combined range clearly supported a 10% impairment rating.  The next higher 20% rating was not justified in the absence of muscle spasms or guarding severe enough to result in an abnormal gait or spinal contour.  Additionally, the Board did not find evidence of intervertebral disc syndrome with VASRD defined incapacitating episodes which would provide for a higher rating under that formula.  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 LBP condition.

Right-Sided Radiculopathy.  According to the STR, the CI first reported a radiculopathy condition in 2004.  He received a temporary L3 profile for “back pain: discogenic with radiculopathies” in October 2004.  The CI was limited from performing push-ups, sit-ups, flutter kicks, jumping exercises, lunges, rack sack, running and carrying more than 10 pounds.  The commander’s statement signed in November 2005 documented the CI received steroid injections [in the low back region] to reduce nerve irritation; however, radiculopathy was not specifically implicated. Electro-diagnostic studies of the right lower extremity (September 2005) were normal without evidence of a radiculopathy.  The probative VA examination, 5 months prior to separation, indicated normal neurologic parameters.
   
The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 8520 code (sciatic nerve), citing mild incomplete paralysis.  The VA assigned a 0% rating using the 5252 code (thigh, limitation of motion) based on the VA C&P examination, citing a history of pain and numbness of the right leg.  Board members agreed that the absence of abnormal clinical findings coupled with normal electro-diagnostic studies would not support a separate and positive impairment rating for a radiculopathy condition.  IAW DoDI 6040.44, the Board may not recommend a rating lower than that received prior to application.  Therefore, all evidence considered, there is not reasonable doubt in the CI’s favor supporting a change from the PEB’s 10% rating decision for the right-sided lower extremity radiculopathy condition.  

BOARD FINDINGS:  In the matter of the low back pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the right-sided radiculopathy condition and IAW VASRD §4.124a, 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 modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140811, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160017216 (PD201403749)

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