RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03763
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070613

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Attack Helicopter Repairer, medically separated  for “back pain secondary to epidural lipomatosis” with a disability rating of 0%.  

CI CONTENTION:  “Please review 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 - 20070507	VARD - 20080522	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Back Pain Secondary to Epidural Lipomatosis	5299-5243	0%	Chronic Low Back Pain…	5237	10%	20071105	
			Epidural Lipomatosis	8022	10%	20080402	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Back Pain Secondary to Epidural Lipomatosis.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in 2001 without any specific injury or trauma.  He reinjured his back in March 2005 and July 2006 in motor vehicle accidents.  Radiographic studies done in August 2006 were unremarkable.  A subsequent MRI dated 16 December 2006 showed mild degenerative disc disease at T3-T4 and an MRI dated 22 January 2007 showed that he had epidural lipomatosis (excessive accumulation of fat within the spinal epidural space, such that the thecal sac is compressed).  The CI was determined to be a nonsurgical candidate and conservative treatments could not adequately rehabilitate his back to meet the physical requirements of his military specialty so the CI was referred for MEB.  The MEB forwarded “chronic low back pain with epidural lipomatosis” for PEB adjudication.  

At the primary care clinic appointment on 28 November 2006, the CI complained of back pain with muscle spasms and muscle aches that worsened with driving, standing, and exercise.  On examination the CI was noted to have an asymmetrical spine with muscle spasms and tenderness.  His gait, motor strength and reflexes were normal.  At the chiropractic clinic appointment on 8 December 2006, the CI complained of low back pain that was exacerbated by standing and sitting.  He reported no radiation of pain and no numbness and tingling in his extremities.  On examination the CI was noted to have tenderness and spasm with normal posture and gait.  The examination indicated that the CI’s lumbosacral spine motion was abnormal, but was silent in regards to range of motion (ROM) measurements.  

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)	PT ~2 Mo. Pre-Sep	VA C&P ~5 Mo. Post-Sep	
Flexion (90 Normal)	50	60	
Combined (240)	165	210	
Comments	Painful motion; tenderness; abnormal gait; spasm; and guarding		
§4.71a Rating	20%	20%	

At the time of the physical therapy ROM study on 4 April 2007, 2 months prior to separation, the CI’s ROM was decreased as indicated in the chart above.  The examiner recorded that all measurements were “assessed using an inclinometer except for side bending and rotation measurements which were assessed with a goniometer.”  ROM limitations were due to pain.  The examiner noted that the CI had tenderness, spasm, and guarding and that the CI’s abnormal gait was due to “muscle spasm or guarding.”  There was no abnormal spinal contour.  

During the MEB examination (recorded on the NARSUM and DD Forms 2807 and 2808) dated 11 April 2007, 2 months prior to separation, the CI reported “recurrent and excessive back pain” with occasional numbness in his “arm and legs.”  The CI also reported that he used a back brace to relieve his pain.  Physical examination showed “no spasm of the paraspinal muscles” of the thoracic spine (the examination was silent in regards to spasm of the lumbosacral spine).  There was no abnormal spinal contour observed by the examiner.  The examiner cited the ROMs from PT as cited and charted above.  

At the 5 November 2007 VA Compensation and Pension (C&P) evaluation, performed 5 months after separation, the examiner recorded that the CI’s back pain did not radiate to his lower extremities and that the CI denied paresthesias (abnormal sensations).  The CI reported that his back condition did not restrict his activities and that he had had no incapacitating episodes in the past 12 months.  Physical examination showed no tenderness to palpation, no muscle spasm, no abnormal gait and no deformity of the spine.  His ROM was limited after repetitive motion as indicated in the chart above.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 0% coded analogously to 5243 (intervertebral disc syndrome (IVDS)).  The VA also rated the back condition 10% coded 5237 (lumbosacral strain), based on the VA C&P examination 5 months after separation, citing forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined ROM of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees.  The VA rated the epidural lipomatosis condition 10% coded 8022 (benign, spinal cord, new growths of) citing minimum evaluation for ascertainable residuals and notes that indicated that the epidural lipomatosis condition was unrelated to the CI’s complaints of low back pain.  

The Board agreed that a 20% rating, but no higher, was justified for limitation of flexion greater than 30 degrees but not greater than 60 degrees reported on the physical therapy and VA examinations; or alternatively the abnormal gait due to muscle spasm or guarding on the physical therapy exam.  There was no documentation of IVDS with incapacitating episodes which would provide for a higher rating under that formula for IVDS.  The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI reported occasional numbness in his “arm and legs” in the STR that were not reported during the VA examination.  Diagnostic imaging studies supported some impingement on the thecal sac from the epidural lipomatosis, but there was no impingement on the cord or nerve roots.  All physical examinations proximate to separation revealed no objective findings of radiculopathy that would impact duty performance.  The Board therefore concluded that an additional disability rating was not justified on this basis.  

The Board next considered if the epidural lipomatosis was a separately unfitting condition, or an underlying component of the CI’s back pain condition.  The treatment record indicated that the back pain was with epidural lipomatosis although the PEB discussed thoracic and lumbar back pain separately.  There were no unfitting symptoms or signs (residuals) from the epidural lipomatosis except for the back pain.  If the epidural lipomatosis were not connected with the back pain, then it would be not unfitting or compensable.  The Board adjudged that although the epidural lipomatosis was not separately unfitting or ratable (absent back pain), that it was most likely associated with the CI’s back pain condition and appropriately combined with the unfitting back pain condition.  

After due deliberation, and considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the back pain secondary to epidural lipomatosis condition, coded 8022-5243.  

BOARD FINDINGS:  In the matter of the back pain secondary to epidural lipomatosis condition, the Board unanimously recommends a disability rating of 20%, coded 8022-5237 IAW VASRD §4.71a.  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 the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Back Pain Secondary to Epidural Lipomatosis	8022-5243	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140718, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXX AR20160011767 (PD201403763)

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.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA