RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03796
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060829

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Light-Wheel Vehicle Mechanic, medically separated for “chronic radiating low back pain…,” with a disability rating of 10%. 

CI CONTENTION:  “Please consider 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 – Dated 20060621	VARD - 20060929	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Radiating Low Back Pain…	5237	10%	Mechanical Low Back-Strain	5237	10%	20060929	
COMBINED RATING:  10%	COMBINED RATING:  10%	

ANALYSIS SUMMARY:

Low Back Pain.  The Medical Evaluation Board (MEB) narrative summary (NARSUM) documented the CI’s report of low back pain (LBP) with radiation into his right leg after sustaining an injury during a rail-load detail in March 2003.  The earliest available treatment entry dated 9 February 2005 documented the chief complaint of LBP without radiation of pain or lower extremity loss of sensation.  Radiographs of the lumbar spine from February 2005 demonstrated mild degenerative disc disease (DDD) at L5-S1 without evidence of fracture, spondylolysis or spondylolisthesis, and mild loss of disc height at L5-S1.  The CI participated in physical therapy and was prescribed narcotic class of pain medication.  He also underwent consultation with physical medicine and orthopedic surgery.  Magnetic resonance imaging of the lumbar spine in January 2006 revealed a left central disc herniation with posterior displacement of the left S1 nerve root (slight) and minimal desiccation of the L5-S1 disc.  At the orthopedic consult in February 2006, the CI noted he had LBP and intermittent leg pain for 3 years.  Medications and modification of activity had not improved his pain.  He could not tolerate his job as a mechanic, could not participate in physical training nor wear Kevlar due to his condition.  The CI underwent a discogram in March 2006 that documented DDD at L5-S1.  L5-S1 fusion surgery was discussed; however, the CI declined.  

At the MEB NARSUM, 12 May 2006, 4 months prior to separation, the CI reported LBP with right-sided leg pain.  Physical examination recorded absence of tenderness to palpation over his lumbar spine, no mid-line defect, wounds or scars in his low back.  Range of motion (ROM) documented forward flexion of “approximately” 25 degrees (normal 90), and 15 degrees of extension (30), opined to be normal “for him and somebody of his body habitus.”  Evidence of lower extremity motor deficit was absent, but sensation to light touch with pinprick was reduced in the right side S1 distribution. Gait was normal.  The physician assessed lumbar degenerative disc and rated his pain as constant and moderate.  A physical therapy exam was conducted on 30 May 2006 or 3 months prior to separation.  The ROM measurements were 50 degrees flexion on 3 trials with a combined ROM of 165 degrees.

The VA Compensation and Pension (C&P) exam was accomplished a month after separation.  The CI reported continued pain at 4-5/10 scale, usually aggravated with bending and prolonged driving.  He had tingling on the right buttock and posterior leg down to his toes with prolonged sitting.  He received relief from lying down, stretching, and elevating his leg.  He did not take any medication but used a back brace whenever he felt like using it.  He worked, sold truck parts at a counter job, where his condition slowed him down; however, he did not loss any time from work due to his condition.  Physical examination documented normal posture, gait and no use of an assistive device.  Lumbosacral spine ROM recorded 90 degrees flexion and 30 degrees extension without loss of motion during repetitive use and without evidence of pain, fatigue, weakness, or lack of endurance.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the condition 10% for tenderness, coded 5237 (Lumbosacral strain).  A higher rating under any of the general spine codes (5235 to 5242) require a ROM limitation of forward flexion of 60 degrees or less, or the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or incapacitating episodes of at least 2 weeks duration secondary to intervertebral disc syndrome.  The Board undertook a careful review of the evidence at hand.  The NARSUM recorded ROM flexion “approximately 25 degrees.”  Physical therapy measurements accomplished 3 months prior to separation documented 50 degrees of forward flexion, and the C&P exam most proximate to separation (a month after separation) recorded 90 degrees of forward flexion.  Board members agreed, the progressive improvement of ROM without the use of medication, is more likely than not, a reflection of the improvement of the back condition over time.  Since episodes of incapacitation were not evidenced in the record, Board members concluded the condition was not ratable under code 5243 (Intervertebral disc syndrome).  There is no VASRD pathway to a rating higher than the minimal compensable rating.  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 low back condition.

BOARD FINDINGS:  In the matter of the chronic radiating low back pain 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 20140724, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

28 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 AR20160009350 (PD201403796)

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