RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04116
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050814

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Light-Wheeled Vehicle Mechanic, medically separated for “low back pain,” with a disability rating of 10%.  

CI CONTENTION:  The CI asserts for a higher rating for his back condition.  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 - 20050602	VARD - 20060227	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Mechanical Low Back Pain	5299-5237	10%	Lumbar Strain…	5237	0%	20051101	
RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Mechanical Low Back Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI hurt his back in June 2001 while changing vehicle batteries and then exacerbated the condition by taking an Army physical fitness test shortly thereafter.   The CI was treated conservatively with pain management and physical therapy.  A bone scan in October 2002 and radiographic studies in August 2004 showed a normal lumbar spine.  A December 2004 magnetic resonance imaging (MRI) study demonstrated congenitally based neural foraminal narrowing (constricted nerve passageway) bilaterally at L4-L5 and L5-S1.  An electromyogram (EMG) study in February 2005 was normal and neurosurgery evaluation in March 2005 determined that the CI was not a surgical candidate.  He underwent a series of epidural injections in March 2005.  Despite treatment, the CI’s back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and he was referred for a MEB.  The MEB forwarded “chronic mechanical low back pain” for PEB adjudication.

At the MEB examination (recorded on DD Form 2807 and 2808 and elaborated further in the NARSUM) on April 2005, 4 months before separation, the CI reported constant dull and aching low back pain, with occasional pain radiating to both knees as well as occasional numbness and tingling of bilateral first toes.  Pain interfered with physical activities such as working out, playing basketball and running; and the CI had difficulty performing military specialty duties to include lifting parts, bending over for lengthy periods, or working in cramped spaces.  Physical examination revealed a normal gait and no visible spine deformity.  Radicular testing (straight leg raise) was negative bilaterally.   Motor strength of the lower extremities was 5/5 bilaterally and reflexes were 2+ and symmetric.   There was some mild tenderness to palpation along the sacrum and bilateral sacroiliac (SI) joints with right lumbar and lower thoracic muscle spasm.  Sensory examination was normal and intact.
  
At the VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported constant non-radiating low back pain.  He did not use any mechanical aids and his pain did not interfere with activities of daily living.  Physical examination showed a normal spine curvature and a smooth and steady gait.  Deep tendon reflexes were intact for bilateral lower extremities.  

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)	NARSUM ~4 Mo. Pre-Sep
	VA C&P ~3 Mo. Post-Sep
	
Flexion (90 Normal)	90 	90	
Extension (30)	20 	30	
R Lat Flexion (30)	30 	30	
L Lat Flexion (30)	30 	30	
R Rotation (30)	30 	30	
L Rotation (30)	30 	30	
Combined (240)	230	240	
Comment	Painful motion with TTP and spasm with normal gait	Deluca neg after 5 reps; no mention of painful motion	
§4.71a Rating	10%	0%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the analogous 5299-5237 (lumbosacral strain) code, citing combined thoracolumbar ROM of 240 degrees with localized tenderness.  The VA assigned a 0% rating using the 5237 code based on the VA C&P examination 3 months after separation, citing forward flexion of the thoracolumbar spine of greater than 85 degrees; or combined ROM greater than 235 degrees.  In assigning probative value, the Board noted that the NARSUM measurements were consistent with other proximate (pre-separation) examinations and more closely approximated the waxing and waning functional impairments associated with back pain.  The Board agreed that a 10% rating, but no higher, was justified for the combined ROM reported in the NARSUM.  Although muscle spasm was also reported in NARSUM, it was not 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 unfitting 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 impairments such as weakness with a direct impact on fitness that were separately unfitting.  The Board therefore concluded that additional disability rating was not justified on this basis.  Finally, there was no documentation of incapacitating episodes which would provide for a higher rating under the alternate VASRD formula for 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 chronic mechanical low back pain condition.    

BOARD FINDINGS:  In the matter of the chronic mechanical 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

SAMR-RB						

05AUG2016

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 AR20160011807 (PD201404116)

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