RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04304
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080814

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Parachute Rigger, medically separated for low back pain with a disability rating of 10%.  

CI CONTENTION:  The CI indicates his back pain has become more severe, and that he suffers from post-traumatic stress disorder (PTSD).  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 upon a 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 - 20080506	VARD - 20090109	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbosacral Strain with Lower Back Pain	5237	10%	Chronic Low Back Pain with Disc Disease and Central Disc Protrusion at L4-L5	5242-5243	0%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Low Back Pain (LBP).  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), this CI’s low back pain (LBP) began in August 2005. Radiographic imaging showed degenerative disc disease (DDD), with disc protrusion at L4-L5.  In October 2007, he was seen by Orthopedics.  The diagnostic impression was DDD, with L4-L5 annular bulge and posterior annular tear (the annulus is the outer ring of the intervertebral disc).  The CI was treated with multiple therapeutic measures.  In spite of all treatment efforts, the LBP persisted.  The MEB forwarded “chronic low back pain with degenerative disk disease and central disk protrusion at L4-L5” for PEB adjudication.  

At the physical therapy (PT) visit on 16 January 2007, 19 months prior to separation, the CI complained of mild low back pain.  He reported that he was able to exercise on an elliptical machine, bike, and jog on a treadmill for 10-15 minutes on each.  On examination, provocative testing for nerve root impingement was negative.  Neurological testing was normal.  Active range of motion (ROM) was “full in all planes.”  

At the orthopedic visit on 2 October 2007, 10 months before separation, the CI reported daily back pain that was persistent and progressive, with intermittent radiation down his right leg, and stopping above the knee.  He denied leg weakness.  Pain was aggravated by prolonged sitting, standing, bending or lifting.  The CI was taking a muscle relaxant (Flexeril), along with non-steroidal anti-inflammatory medication.  On examination, neurologic testing was normal and provocative maneuvers for nerve root irritation were negative.  Gait was normal, with no tenderness or abnormal spinal contour.  The examiner reported full ROM of the thoracic spine.  Lumbar spine ROM was reported as “fingertips approximately eight inches from the floor with flexion” and “extension of approximately 15° with mild low back pain.”  Radiographic imaging studies showed degenerative changes, with the same disc bulge and annular tear as noted on previous studies.
 
The MEB NARSUM examination on 7 April 2008, 4 months prior to separation, noted complaints of low back pain present 70% of the time.  The pain radiated down his right leg and into the lateral portion of his right foot.  This would occur twice per week, lasting 10-15 minutes, and was associated with some tingling in that portion of the right foot.  The CI indicated he was unable to run, stand more than 15 minutes or sit for greater than 30 minutes.  The back pain was improved with application of heat, and he was taking no medications.  Physical examination showed normal neurological results.  Provocative testing for nerve root impingement was negative.  There was no tenderness of the spine, and no spasm or deformity of the back.  Gait was reported as slightly antalgic.  The ROM was normal.  The VA did not perform a Compensation and Pension (C&P) evaluation.

The Board directed attention to its rating recommendation based on the evidence.  The PEB rated the low back condition 10% coded 5237 (lumbosacral strain), citing painful motion.  The VA rated the low back condition 0% coded 5242-5243 (degenerative arthritis of the spine, with intervertebral disc syndrome), citing lack of evidence indicating the current condition of the disability.  Although there was insufficient limitation of motion to support a minimum rating, the Board agreed a 10% rating was justified for the presence of painful motion, as reported on the NARSUM.  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 evidence of incapacitating episodes requiring physician-prescribed bed rest, to warrant consideration of rating under the alternate VASRD formula for intervertebral disc syndrome (IVDS).  There was no associated radiculopathy for a 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, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication for the LBP condition (lumbosacral strain).  

BOARD FINDINGS:  In the matter of the lumbosacral strain and IAW VASRD §4.59, 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 20140301, 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 XXXXXXXXXXXXXXXXXXXXX AR20160011857 (PD201404304)

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