RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00176
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040301

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, Automated Logistical Specialist, medically separated for “chronic back pain” rated at 10%. 

CI CONTENTION:  The CI contends that she was given a higher rating for her condition by the VA and she requests to have all of her other disability ratings and conditions awarded and denied by the VA reviewed for consideration.  Her 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:  

IPEB - Dated 20031215	VA* - (~2 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5243	10%	Degenerative Disk Disease, Lateral Disk Herniation L4-5 with Sciatica	5243	20%	20040106	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 8 	
RATING:  10%	RATING:  60%	
*Derived from VA Rating Decision (VARD) dated 20040506 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Chronic Back Pain Condition.  According to the narrative summary (NARSUM), the CI’s low back pain began in January 2001 after falling in basic training.  Radiographs (MRI studies), in May 2003, showed degenerative disk disease at L4-5, with later MRI, 8 Jan 2004, showing no neural compression, minimal spondylosis, with minor degenerative disease.  

Despite treatment, physical therapy (PT), chiropractor, the CI’s back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and was referred for a Medical Evaluation Board (MEB).  

The MEB NARSUM examination on 3 September 2003 (6 months prior to separation) noted complaints of back pain with radiation into both legs.  She had no relief of back pain with PT, chiropractor, or epidural steroid injections with inability to do her military duties, wear body armor, run, or lift.  Physical examination showed “20 degrees of lumbar flexion, 10 degrees of extension” and bending to each side.  Straight leg raise (for radiating symptoms) was positive on the right.  There was decreased light touch sensation in the left S1 distribution.  There was weakness (4/5) to plantar flexion.  Reflexes were normal.  

At the time of the PEB-requested PT range-of-motion (ROM) evaluation on 12 December 2003, the CI reported back pain with radicular symptoms in both legs.  She had current left leg symptoms with reported bilateral leg symptoms occasionally.  On examination active ROM was measured three times as flexion of “63, 64, 52” degrees and extension of “12, 15, 15” degrees.  

At the VA Compensation and Pension (C&P) examination performed 6 January 2004, 2 months before separation, the CI reported similar history and symptoms as in the MEB.  Examination showed tenderness of the lumbosacral spine with some paraspinal spasm, with diminished sensation to touch on the left side, with motor function 4+/5 on the right and 4/5 on the left.  Posture and gait were normal.  

At the time of the consultation appointment performed 27 Jan 2004, 1 months before separation, the CI reported her pain was above her belt line and radiating to her lower extremities described as constant, throbbing, pressure, sharp pain, 5-8/10 on the pain scale, without loss of bowel or bladder function.  She also reported numbness and tingling, with left lower extremity weakness associated with pain.  Physical examination showed a normal gait and station.  There was tenderness to palpation.  ROM was forward flexion to 60 degrees (normal 90) and combined 190 degrees (normal 240).  Sensory was intact, motor and reflex exams were normal.  The examiner stated that “no neurosurgical intervention can be offered….”  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under 5243 (degenerative disk disease) citing L4-5 HNP without significant neurological abnormality and forward flexion to 64 degrees.  The VA assigned a 20% rating under 5243 (degenerative disk disease) based on the VA C&P examination on 6 January 2004, 2 months before separation, citing limited ROM, forward flexion at 50 degrees, pain, and muscles spasms during the exam.  The VA also noted the CI’s sciatica stating that “under the rating criteria for sciatica, a noncompensable evaluation is assigned unless there is incomplete paralysis below the knee which is mild.”  

The PEB cited 64 degrees flexion appeared to be from the PT examination 3 months prior to separation; however, that examination indicated 52 degrees (50 degrees following VASRD spine formula note 4 for rounding) following repetition.  Flexion of 50 degrees would support a 20% rating; however, that examination also did not provide comprehensive goniometric ROM measurements IAW VASRD guidance as there was no lateral flexion or rotation measurements provided.  The subsequent pre-separation VA examination and consult documented forward flexion of 50 and 60 degrees with more comprehensive ROM testing.  

The Board considered that the VA examination had the highest probative value for rating at separation.  The Board agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees) as reported on the VA examination.  
The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI had pain radiating to the lower extremities; however examinations indicated normal reflexes and gait with minor motor and sensory deficits that did not affect her job.  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.  The PEB description was adjudged as a finding of not unfit radiculopathy; therefore the evidence standard is preponderance of the evidence.  There was insufficient evidence in this case that motor weakness existed to any degree that could be described as functionally impairing.  The Board therefore concludes 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 recommends a disability rating of 20% for the chronic back pain condition, coded 5243.  

BOARD FINDINGS: In the matter of the chronic back condition, the Board unanimously recommends a disability rating of 20%, coded 5243 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 her prior medical separation:  

CONDITION	VASRD CODE	RATING	
Chronic Back Pain	5243	20%	
RATING	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150225, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB										

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 
XXXXXXXXXXXXXXXXXX, AR20160014230   (PD201500176)

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