RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04106
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060713

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Unit Supply Specialist, medically separated by the Informal Physical Evaluation Board (IPEB) for “chronic low back pain [LBP]” with a disability rating of 10%.

CI CONTENTION:  His conditions continue to worsen and negatively impact his daily activities.  His 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 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 – 20060518	VARD - 20061201	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP…	5237	10%	Chronic LBP	5237	10%	STR	
Neck Pain	Not Unfitting	Neck Pain with Headaches	5237-8100	NSC	STR	
Recurrent Sprains of Left Ankle	Not Unfitting	Left Ankle Sprain	5271	0%	STR	
RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Chronic LBP Condition.  According to the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back pain began in November 2004, when the CI took a missed step and impacted the bumper of a truck.  X-rays of the lumbar spine, 22 November 2004, were normal.  The CI experienced persisting back pain with episodic shooting pain into the left leg.  A magnetic resonance imaging (MRI) scan of the lumbosacral spine, 30 March 2005, showed a normal lumbosacral spine without any evidence of intervertebral disc abnormalities, narrowing of neuroforamina (space through which the spinal nerve roots pass), or compression of nerve structures.

At the time of the neurology clinic appointment on 3 November 2005 (8 months prior to separation) the CI reported LBP radiating to the left leg, precipitated by exertional physical activities and reported intermittent paresthesia/numbness to both feet when he woke up in the morning.   There was no weakness or muscle spasm.  On examination, there was subjective numbness of the left leg but the neurologic examination was otherwise normal.  The gait, lower extremity strength and reflexes were normal.  Electro-diagnostic studies that day were negative for evidence of radiculopathy or neuropathy.

At the time of the orthopedic clinic appointment on 29 November 2005 (8 months prior to separation) the CI reported chronic LBP with episodic shooting pain into the left leg with numbness in the left leg (outside aspect) occurring a couple of times per day and lasting up to 15 minutes.  On examination, he could reach his fingers to the middle of his shins before the onset of back pain (approximately 70 degrees).  There was no muscle spasm and the gait was normal.  The CI reported decreased sensation on the medial (inner aspect) of the calf however, strength and reflexes of both lower extremities were normal.  The orthopedic surgeon reviewed the MRI noting it was entirely normal.  He concluded with a diagnosis of mechanical LBP.

Despite treatment (physical therapy [PT] and chiropractor), 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 MEB NARSUM exam on 19 April 2006 (3 months prior to separation) noted complaints of baseline pain in the lower back of 2 to 3/10, increasing 7-8/10 with physical activity (i.e. sit-ups or heavy lifting).  Physical exam showed 75 degrees of lumbar flexion (normal 90) and 15 degrees extension (normal 30) and combined range-of-motion (ROM) of 175 degrees.  There was no VA Compensation and Pension examination proximate to separation and the VA based its service-connected rating on the service medical records.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under 5237 (lumbosacral strain) citing pain-limited spinal flexion, no radiculopathy, muscle spasms, and presence of paraspinal muscle tenderness to palpation.  The VA assigned a 10% rating under 5237 (lumbosacral strain) based on service treatment records 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.  

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 the combined ROM (greater than 120 degrees but not greater than 235 degrees) reported on the MEB NARSUM examination.  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 associated radiculopathy for separate peripheral nerve rating.  Although the CI experienced radiating pain, there was no objective evidence of a radiculopathy or functional impairment with a direct impact on fitness.  While the CI may have experienced radiating pain from the back condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  There is no evidence in this case that there was radiculopathy with associated functional impairments that were separately functionally impairing.  The Board therefore concludes that an additional disability rating was not justified on this basis.  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.

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the neck pain and recurrent sprain of ankle were not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The neck pain and recurrent sprain of ankle were not profiled or implicated in the commander’s statements and were not judged to fail retention standards.  All were reviewed and considered by the Board.  There was no performance-based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance.  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 the any of the contended conditions and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the chronic LBP condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended neck pain and recurrent sprains of the left ankle 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, 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 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 AR20160005475 (PD201404106)

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