RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04157
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070810

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Infantryman, medically separated for “chronic low back pain,” with a disability rating of 20%.  

CI CONTENTION:  “Review all records.”  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 - 20070712	VARD - 20080219	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5237	20%	… Chronic Low Back Pain	5242	20%	20071001	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic low back pain condition began in November 2005 after striking a barrier while riding in a tactical vehicle (forced flexion injury) in Iraq.  Magnetic resonance imaging (MRI) studies on 9 August 2006 showed minimally altered lumbar curvature with normal vertebral alignment, and minimal bulging of the intervertebral disks at L4-5 and L5-S1 levels, without herniation or nerve impingement.  Radiographic studies on 8 December 2006 documented mild to moderate degeneration at the L5-S1 vertebral articulations (facets joints) and bulging intervertebral discs with an incidental finding of spina bifida occulta at S1 (congenitally malformed vertebrae).  There was no evidence of spondylolysis (fractures between the vertebral joints) or significant degenerative bony articulations (facet joints) at other vertebral levels.  There was no surgical indication, and conservative treatment (to include epidural steroid and facet injections) did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “lumbar back pain” for PEB adjudication.  

At the MEB NARSUM examination dated 27 April 2007 (3 months pre-separation), the CI reported 4/10 pain at rest that increased to 7-8/10 with activity.  Physical examination showed tenderness with muscle spasm and abnormal gait; however, spinal contour was normal.  Thoracolumbar flexion was to 50 degrees (normal 90) after repetition and was limited by pain.  

At the VA Compensation and Pension (C&P) examination performed on 1 October 2007 (2 months post-separation), the CI reported 7/10 pain that occasionally radiated to the posterior right lower extremity with cramping.  The pain was aggravated by lifting, bending, going down stairs, and with prolonged sitting and standing.  Physical examination showed tenderness with muscle spasm; however, gait was normal.  Provocative maneuvers for radiculopathy (radiating pain due to spinal nerve root or sciatic nerve involvement) were negative.  Thoracolumbar flexion was to 60 degrees after repetition and was limited by pain.  Radiographs documented unilateral L5 spondylolysis (pars fracture) without spondylolisthesis (slippage).  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB rated the chronic low back pain condition 20% coded 5299-5237 (lumbosacral strain), citing tenderness, muscle spasm, abnormal gait, and painful limitation of range of motion.  The VA  also rated the chronic low back pain condition 20% coded 5242 (degenerative arthritis of the spine), based on the VA C&P examination 2 months after separation, citing degenerative facet joint changes at L5-S1 bilaterally with bulging discs, lumbar lordosis, and unilateral spondylosis.  The Board deliberated the evidence for a higher rating.  The MEB NARSUM documented flexion to 50 degrees while the VA C&P evaluation documented flexion to 60 degrees with no additional limitations after repetition.  The Board agreed that both examinations provided evidence that reached the 20% rating criteria, but no higher, for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees.  There was no documentation of physician prescribed bedrest for incapacitating episodes of at least 4 weeks but less than 6 weeks for a higher rating under the code for intervertebral disc syndrome.  The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI reported intermittent radiating pain to his right lower extremity.  The presence of functional impairment with a direct impact on fitness is the key determinant in the Board’s decision to recommend any condition for rating as additionally unfitting.  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 is no evidence in this case that motor weakness existed to any degree that could be described as functionally impairing.  The Board therefore concluded that 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 chronic low back 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 AR20160011605 (PD201404157)

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