RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04160
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040531

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Food Service Specialist, medically separated for “chronic low back pain without neurologic abnormality,” with a disability rating of 10%.

CI CONTENTION:  The CI contends he was more than 20% disabled.  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 - 20040406	VARD - 20040722	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5299-5237	10%	Mechanical Low Back Pain	5243	20%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Low Back Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back pain began in approximately December 2001 but was exacerbated while deployed in 2003.  An X-ray in January 2003 showed early degenerative changes at L5-S1.  At the time of the orthopedic clinic visit on 22 October 2003, the CI reported worsening back pain with numbness in his legs and feet and denied bowel or bladder dysfunction.  He rated his pain 6/10.  On examination the CI was able to flex to within ten inches of the floor and extend 15 degrees with painful motion.  Tenderness of the lower paraspinal muscles was present.  Deep tendon reflexes (DTRs), strength, and sensation were normal.  Straight leg raise tests (assess for herniated disc causing sciatic nerve root [L5-S1] radiculopathy) were negative.  Physical therapy (PT) was initiated.  Magnetic resonance imaging (MRI) in November 2003 was noted to be normal.  There was no surgical indication, and conservative treatment to include PT, chiropractic manipulation, epidural steroid injections, nonsteroidal anti-inflammatory drugs, and muscle relaxants did not result in improvement sufficient to allow unrestricted duty.  Despite treatment, the low back pain 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 “low back pain” for PEB adjudication.

A 14 February 2004 MRI showed a minimal broad-based posterior disk bulge, ligamentous hypertrophy, and facet joint arthropathy at L5-S1.  The 25 February 2004 MEB NARSUM examination, 3 months before separation, noted complaints of back pain with radicular symptoms in both lower extremities.  Physical examination showed a normal gait, diffuse lumbosacral tenderness with paraspinal muscle spasms, and limited painful flexion.  There was no muscle atrophy in the lower extremities and DTRs, strength, and sensation were normal.  The examiner noted the remainder of the examination “was otherwise negative.”  Lumbosacral range of motion (ROM) measurements performed by PT on 3 March 2004 showed flexion of 45 degrees (normal 90) and combined ROM of 145 degrees (normal 240).  The VA used the service treatment records for their rating purposes.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating analogously coded 5299-5237 (lumbosacral strain), citing limitation of thoracolumbar ROM due to pain with localized tenderness.  The VA assigned a 20% rating coded 5243 (intervertebral disc syndrome) based on the STR, citing forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees.  The Board agreed that a 20% rating, but no higher was justified for limitation of flexion reported on the PT ROM examination.  There was no evidence of intervertebral disc syndrome (IVDS) which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate IVDS VASRD formula.  There was no evidence of an associated unfitting radiculopathy for consideration of a separate peripheral nerve rating.  Motor strength was normal.  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).”  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the low back condition, coded 5237.

BOARD FINDINGS:  In the matter of the low back condition, the Board unanimously recommends a disability rating of 20%, coded 5237 IAW VASRD §4.71a.  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	
Low Back Pain without Neurologic Abnormality	5237	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 AR20160011607 (PD201404160)

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