RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03916
BRANCH OF SERVICE:  Army	separation DATE:  20090227

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Military Policeman, medically separated for “lumbosacral strain,” with a disability rating of 10%.  

CI CONTENTION:  The CI contends for his back and left knee.  The applicant’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 - 20081212	VARD - 20090429	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbosacral Strain	5237	10%	L4-S1 Degenerative Disc Disease	5242	10%	20081208	
COMBINED RATING:  10%	COMBINED RATING FOR ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Lumbosacral Strain.  According to service treatment records the CI’s back pain was long standing and of uncertain origin.  Radiographic studies (X-rays in February 2007) were within normal limits with a magnetic resonance imaging (MRI) in April 2007 documenting arthritis, a lumbar spine disc herniation/protrusion and short pedicles producing mild-to-moderate central spinal canal stenosis (narrowing of the spinal canal).  Clinic evaluations documented continuing complaints of back pain with painful lumbosacral motion without radiating pain or signs of radiculopathy.  Follow-up MRI in September 2007 showed mild degenerative disc disease with posterior disc protrusion at L4-L5 and L5-S1.  A June 2008 physical medicine and rehabilitation examination showed “lumbar extension is 20% of normal, flexion is full.”  The CI received a series of epidural steroid injections and a follow up MRI in July 2008 demonstrated spondylosis (degeneration) at the L4-L5 (likely disc herniation) and L5-S1 (bulging discs) levels.  

An orthopedic evaluation in August 2008 indicated chronic non-radiating back pain worsened with standing and walking, but not worse with bending.  There were no complaints of radicular symptoms.  Exam showed a normal appearing lumbosacral spine, no muscle spasms, no tenderness to palpation (TTP), no spine deformity, and negative testing for radicular symptoms.  Sensory, motor, and reflex examinations were normal.  The specialist concluded with diagnoses of lumbar spondylosis (L4 - LS) and (LS - S1).  The CI was not a surgical candidate.  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 a Medical Evaluation Board (MEB).  
	
The range of motion (ROM) evaluations 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 ~4 Mo. Pre-Sep	VA C&P ~2 Mo. Pre-Sep	
Flexion (90 Normal)	90	70	
Combined (240)	240	200	
Comments	“When evaluated under DeLuca's guidance it was felt that there would be a little, if any, loss of range of motion”	Deluca positive (see text)	
§4.71a Rating	0%-10% (PEB 10%)	10%	

The MEB narrative summary (NARSUM) examination on 21 October 2008 (4 months prior to separation) noted complaints of chronic aching low back pain 6-7/10 increasing with activity (running, prolonged standing, heavy lifting) to 8-9/10.  The CI denied any radiating pain, no bladder, bowel or erectile dysfunction, no loss of sensation or weakness.  The CI was taking no pain medication at the time.  Physical exam showed normal and equal muscle bulk, 2+ deep tendon reflexes (DTR), normal power, tone and coordination with no sensation loss.  

At the VA Compensation and Pension (C&P) examination on 8 December 2008, performed 3 months before separation, the CI reported having daily back pain, mild to moderate in severity, exacerbations) occurring one to ten times a month.  During work, he reported having to get up and stretch his back every 20 minutes.  The CI reported no paralysis, no foot drop or drag and normal bladder and bowel function.  Physical exam showed normal gait and posture, normal thoracic spine, and ROM testing included the examiner stating:  “In the lumbar spine, because of the pain and the impaired endurance, initially the lumbar curve mildly reversed ….”  There were no radicular symptoms during the ROM testing.  DeLuca testing (repetitive testing for loss of endurance, coordination) caused increased pain and decreased ROM as charted above.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the lumbosacral strain condition 10% coded 5237 (lumbosacral strain), citing no radiating pain on exam with normal strength, normal reflex, no sensory deficit and ROM at 90 degrees forward flexion.  The PEB annotated that its 10% rating considered VASRD §4.10 (functional impairment), §4.40 (functional loss), and § 4.59 (painful motion).  The VA also rated the CI’s lumbosacral strain condition 10% coded 5242 (degenerative arthritis of the spine), based on the VA C&P examination 2 months before separation, citing the 10% ROM criteria.  

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) reported on the VA examination, 3 months prior to separation.  There was no muscle spasm or guarding severe enough to result in abnormal gait.  In considering other pathways to a higher rating, it was noted that pain with an abnormal spinal contour may have been present during initial VA ROM testing, although this was an inconsistent finding.  All other physical rating criteria during this examination, as well as examinations conducted prior to this by the Service, did not support the next higher rating (20%) in this case.  Finally, there was no documentation of incapacitating episodes which would provide for a higher rating under that formula or evidence of ratable peripheral nerve impairment which would provide for additional 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 lumbosacral strain condition.  

BOARD FINDINGS:  In the matter of the lumbosacral strain 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 20140901, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 (PD201403916)

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