RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04045
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060531

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E5, Concrete and Asphalt Equipment Operator, medically separated for “chronic low back pain,” with a disability rating of 10%.

CI CONTENTION:  The CI requests consideration of 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 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 - 20041115	VARD – 20061017	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5237	10%	Degenerative Disc Disease, Lumbar Spine, L-4-5, S-I	5242	20%	20060422	
			Bilateral Lower Extremity Radiculopathy with Neuroforaminal Stenosis	8620	NSC		
Supraventricular Tachycardia	Not Unfitting	Supraventricular Tachycardia	7010	NSC	STR	
Hearing Loss		Bilateral Hearing Loss	6100	NSC	20070510	
Hypertriglyceridemia		No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain without Significant Neurologic or Electro-diagnostic Abnormality.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic low back pain condition began in June 1999 after falling off of asphalt equipment.  Diagnostic imaging (X-ray) studies on 21 June 1999 showed degenerative disc disease at the L5-S1 level with vacuum disc phenomenon.  Diagnostic imaging (MRI) studies on 7 May 2001 showed bulging intervertebral discs, degenerative disc disease, and nerve impingement.  The CI continued to have back pain and in July 2001 he was put on a P3 profile that limited him to walking and no rucksack marching.  Electro-diagnostic studies (EMG/NCV) performed on 22 March 2004 were negative for radiculopathy.  There was no surgical indication and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “lower back pain, pain is slight and constant,” for PEB adjudication.  During the MEB examination dated 15 November 2004, 18 months prior to separation, the CI reported constant low back pain that interrupted his sleep.  The pain prevented him from taking a physical fitness/alternate physical fitness test or perform functional activities.  He could not lift more than 10 pounds, carry a ruck sack, or wear protective body armor; severely impacting his ability to perform his military specialty.  Physical examination showed right-sided tenderness to palpation, reduced muscle strength, and positive radicular testing.  There was pain limited thoracolumbar range of motion (ROM) to 80 degrees of flexion (normal 90) and 10 degrees of extension (normal 30). 

At the 22 April 2006 VA Compensation and Pension (C&P) evaluation, performed a month before separation, the CI reported daily, constant, sharp low back pain that radiated down his right lower extremity to the foot.  The pain increased to 9/10 during flare-ups; which occurred 3-4 times weekly.  Physical examination showed abnormal gait, bilateral paraspinal muscle tenderness to palpation, muscle spasm on the right, and positive radicular testing.  There was normal strength and reflexes.  There was pain limited thoracolumbar range of motion to 50 degrees of flexion (normal 90) and 20 degrees of extension and right lateral flexion (normal 30).

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic low back pain condition 10% coded 5299-5237 (lumbar spine strain), citing tenderness.  The VA rated the chronic low back pain condition 20% coded 5242 (degenerative arthritis of the spine), citing limitation of forward flexion.  The Board placed higher probative value on the VA examination based on its proximity to separation.  It was noted that muscle spasm associated with an abnormal gait was present on the VA examination.  The Board agreed the evidence supports a 20% rating for muscle spasm or guarding severe enough to result in an abnormal gait.  There was no evidence for a rating higher than 20%.  The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI reported radiating symptoms and intermittent numbness to his right foot; however, the electro-diagnostic studies showed no evidence of neuropathy or radiculopathy.  While the CI may have suffered additional pain from the nerve involvement, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  Therefore the critical decision is whether or not there was a significant motor weakness which would impact military occupation-specific activities.  There was no evidence in this case that motor weakness existed to any degree that could be described as functionally impairing.  The Board therefore concluded that an additional disability rating was not justified on this basis.  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 chronic low back pain condition, coded 5242.

Contended PEB Conditions:  Supraventricular tachycardia (SVT), hypertriglyceridemia, and hearing loss.  The supraventricular tachycardia (SVT) and hypertriglyceridemia were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.  Although, the hearing loss was profiled, during the MEB examination, the condition was deemed to meet retention standards and was not implicated in the commander’s statement.  There was no performance-based evidence from the record that the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, and in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for supraventricular tachycardia (SVT), hypertriglyceridemia, and hearing loss and so no additional disability ratings are recommended.  
BOARD FINDINGS:  In the matter of the chronic low back pain condition, the Board unanimously recommends a disability rating of 20%, coded 5242 IAW VASRD §4.71a.  In the matter of the contended supraventricular tachycardia (SVT), hypertriglyceridemia, and hearing loss conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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	
Chronic Low Back Pain	5242	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated w/atchs
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 AR20160013672 (PD201404045)

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