RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03816
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040928

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

CI CONTENTION:  His condition continues to worsen.  The applicant also has a neck condition that was not known at the time of separation.  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 - 20040826	VARD - 20041020	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain…	5299-5237	10%	Capitalize Each Word	5299-5243	10%	STR	
RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Chronic Low Back Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in approximately January 2002. The CI denied any specific injury or trauma.  Magnetic resonance imaging studies performed in December 2002 showed degenerative disc disease with disc bulge that may affect the right S1 nerve root.  There was no surgical indication.  At the time of the orthopedic clinic appointment on 2 June 2004, the examiner recorded that the CI was currently on profile, taking medication, and going to therapy.  He also noted that the CI denied bowel or bladder dysfunction and radicular pain.  On examination the CI could “heel toe walk” and had normal strength, sensation and reflexes.  He was noted to have tenderness in his lumbar area, but no spasms.  He was able to “bend to floor,” had some decrease in his extension as noted in the chart below, and had painful motion in all planes with mildly positive test (Patrick test) for right sacroiliac joint pain.  

At the time of the physical therapy clinic appointment on 4 June 2004, the CI reported that his back pain was aggravated by standing, lifting, and bending.  On examination he had normal gait, strength and reflexes.  He could forward flex to toes with pain, he had a 50% decrease in extension with pain, had normal motion with pain while performing right and left side bends as noted in the chart below and had a slightly positive test for sacroiliac joint pain. Straight leg raise testing (for radiating symptoms) was negative. He was unable to do an unsupported sit-up.  Despite treatment, the CI’s back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and was referred for an MEB.  

The range-of-motion (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)	Ortho ~4 Mos. Pre-Sep	PT ~4 Mos. 
Pre-Sep	MEB ~3 Mo. Pre-Sep	PT ~1 Mo. Pre-Sep	VA C&P ~3 Mo. Post-Sep	
Flexion (90 Normal)	“bend to floor”	“to toes”	90	65*	90	
Combined (240)	-	-	210	185	240	
Comments	Limited motion, painful motion, and tenderness 	Limited motion, painful motion	Limited motion and tenderness	*Inclinometer at L1; Lumbar motion not thoracolumbar
Painful motion	No change after repetitive motion
Painful motion
Normal gait	
§4.71a Rating	10%	10%	10%	10%	10%	

At the MEB examination (recorded on DD Form 2807 and 2808) dated 29 June 2004, 3 months prior to separation, the CI reported chronic back pain caused by L5-S1 disk bulge. On examination he had normal gait, sensation, strength and reflexes. Although he had no superficial tenderness, he was noted to have deep tenderness to palpation in the L5-S1 region. He also had some limitation of motion as indicated in the chart above.  The MEB NARSUM, dated 26 July 2004, (2 months prior to separation) noted complaints of increasing exacerbations of his back pain.  The physical exam section of the NARSUM was extracted from the MEB examination performed on 29 June 2003 and contains no additional information.  At the time of the physical therapy clinic appointment on 23 August 2004, a month prior to separation, the CI reported for ROM measurements.  The examiner noted that he used an inclinometer placed at L1 for all measurements except rotation, and therefore measured lumbar spine motion but not thoracolumbar motion as specified in the VASRD.  The CI’s ROM was limited as indicated in the chart above with one caveat, the examiner noted that although the CI’s extension was 0 degrees while standing, in the prone position he was able to extend to 35 degrees.  

At the VA Compensation and Pension (C&P) examination on 20 December 2004, performed 3 months after separation, the CI reported that he had not lost any workdays because of illness over the last 12 months and that he had worked as a mechanic in a local garage since his release from active duty.  The examiner also recorded that “today, the veteran has no complaints about his back.” Physical exam showed normal gait and posture and normal strength, sensation and reflexes in the lower extremities.  He had full ROM (normal; see chart) with pain “towards the end of each motion.”  The examiner noted that “repetitive movements of the lumbosacral spine caused an increase in pain, weakness, fatigue, and lack of endurance without any restriction on ROM.” There was no complaint of back pain radiating into his lower extremities and his neurologic exam was normal.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the analogous 5299-5237 code (analogous to lumbosacral strain), citing limitation of motion due to pain and localized tenderness.  The VA also assigned a 10% rating using an analogous 5299-5243 code (analogous to intervertebral disc syndrome), based on service medical records, citing what appears to be limitation of forward flexion and limitation of combined motion.  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 combined ROM greater than 120 degrees but not greater than 235 degrees and/or painful motion and/or tenderness as reported on all examinations proximate to separation.  There was no muscle spasm or guarding severe enough to result in abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no evidence of intervertebral disc syndrome resulting in incapacitating episodes requiring bed rest prescribed by a physician to warrant consideration of rating under the alternate VASRD formula based on incapacitating episodes due to intervertebral disc syndrome.  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 20140811, 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 AR20160009366 (PD201403816)

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