RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04107
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20031219

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Shower/Laundry and Clothing Repair Specialist, medically separated for “chronic low back pain,” with a disability rating of 10%.

CI CONTENTION:  Her back condition has worsened impacting her daily activities.  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 on 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 – 20031001	VARD - 20040519	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Degenerative Disc Disease of the Lumbar Spine	5010-5242	20%	20040420	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  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 August 2001 after falling down.  Diagnostic imaging (MRI) studies in May 2003 showed mild degenerative disc disease at L5-S1 without foraminal (space through which the spinal nerve root passes) or spinal canal impingement.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic low back pain” for PEB adjudication.

At an orthopedic evaluation on 20 June 2003 (6 months prior to separation), the CI complained of pain with heavy lifting, running, prolonged standing and sitting.  She reported intermittent radiating symptoms from her left thigh to the knee.  The examiner reported trunk flexion with fingers reaching to mid-shin [approximately 65-80 degrees (normal 90 degrees) of thoracolumbar flexion]; and lateral bending as fingers reaching the knees [approximately 30 degrees (normal)].  Lumbar tenderness was absent, lower extremity muscle strength was normal, and a test for nerve root irritation was negative. 

During the MEB NARSUM examination dated 9 July 2003, the CI reported constant lower back pain that prevented her from road-marching with a 35-pound pack, and from wearing a ruck sack, load-bearing equipment, or a Kevlar helmet.  She could not walk greater than 100 yards without significant pain.  Physical examination showed normal lower extremity muscle strength.  A maneuver for nerve root irritation was negative.  The report recorded flexion as “170 degrees” [likely a typographical error and should have indicated flexion as 70 degrees] and combined range of motion (ROM) was 220 degrees.  Lower extremity neurologic findings were normal, and a test for nerve root irritation was negative.

At the 7 April 2004 VA general medicine Compensation and Pension (C&P) evaluation, performed 4 months after separation, the CI reported chronic low back pain.  Physical examination showed a normal gait, normal spinal contour and no muscle spasm.   There was no sign of nerve root irritation.  Thoracolumbar flexion was “about 80 degrees.”

At the 20 April 2004 VA spine C&P evaluation, the CI reported persistent daily low back pain which radiated down her left leg.  She was able to perform activities of daily living except walking long distances, bending and lifting; she denied incapacitating episodes.  Physical examination showed normal reflexes and spinal contour.  There was lumbar spasm, but spinal contour was normal and gait was not mentioned.  Testing was negative for radiating symptoms to the lower extremities.  Thoracolumbar flexion was 60 degrees and combined ROM was 140 degrees.  Repetitive motion did not result in a change in ROM.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic low back pain condition 10%, coded 5237 (lumbosacral strain) citing mild degenerative changes with no radiculopathy or muscle spasm.  The VA rated the condition 20%, analogously coded 5010-5242 (arthritis due to trauma-degenerative arthritis of the spine), based on the VA C&P examination 4 months before separation, citing limitation of flexion.  Although one VA examination after separation supported a 20% rating for forward flexion greater than 30 degrees but not greater than 60 degrees, the ROM from all other examinations in evidence justified a 10% rating (flexion greater than 60 degrees but not greater than 85 degrees, or combined ROM greater than 120 degrees but not greater than 235 degrees).  The Board concluded that the totality of this evidence supported a 10% rating.  There was no evidence of muscle spasm or guarding severe enough to cause an abnormal gait or spinal contour, thus a 20% rating was not justified on this basis.  The Board also considered whether a higher rating (§4.7) was achieved by using the alternate rating formula based on incapacitating episodes due to intervertebral disc syndrome (IVDS).  Although the CI had intervertebral disc disease there were no incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula (for IVDS).  Finally, there was no associated radiculopathy for separate peripheral nerve rating.  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 was no objective evidence of a radiculopathy with functional impairment (such as weakness) that directly impacted fitness for duty.  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 concluded that there was insufficient cause to recommend a change in the PEB adjudication for the chronic low back pain condition.

BOARD FINDINGS:  In the matter of the chronic 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 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 AR20160011831 (PD201404107)

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