RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00296
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080525

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Army National Guard E4, Combat Engineer, medically separated for “low back pain…(LBP)” with a disability rating of 10%.  

CI CONTENTION:  “Please consider all conditions.”  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 - 20080328	VARD - 20090122	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5299-5237	10%	Intervertebral Disc Degeneration, with Herniated Lumbar Disc	5243	NSC	20080710	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Low Back Pain (LBP).  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back condition began in July 2007 following a physical fitness test.  No injury or trauma was noted.  At the physical therapy (PT) visit on 26 September 2007, the CI reported constant low back and right posterior thigh pain.  The CI denied any loss of bowel or bladder control.  There was no muscle weakness or loss of control in the legs and feet.  The examiner noted normal reflexes, with normal heel and toe walking bilaterally.  Straight leg raise (SLR) testing achieved 60 degrees on the right, and 70 degrees on the left. Range of motion (ROM) measurements showed forward flexion to 40 degrees, with combined ROM at 135 degrees.  Magnetic resonance imaging (MRI) on 11 October 2007 showed degenerative disc disease (DDD) at L4-L5 and L5-S1, with neural foraminal narrowing and central bulging, but the discs did not impinge on the nerve roots or thecal sac.  At the orthopedics visit on 17 December 2007, the CI reported left leg and back pain.  Right leg pain was reported as intermittent.  The CI said he had not received relief from PT.  He was referred to neurosurgery and determined not to be a surgical candidate.  Despite all treatment efforts, the back condition did not improve adequately to meet the physical requirements of the CI’s military specialty, and he underwent an MEB.  The MEB forwarded “low back pain” for PEB adjudication.  

The MEB NARSUM examination on 31 January 2008, 4 months prior to separation, the CI reported back pain that was exacerbated by standing or physical activity.  It was alleviated by lying down and medication.  The physical examination (PE) showed normal gait and stance, with normal heel and toe walking.  Bilateral lower extremity neurologic examination was normal.  Forward flexion was 100 degrees (90 normal) with combined ROM of 210 degrees (240 normal).  

At the primary care visit on 28 February 2008, 3 months prior to separation, the CI reported a flare up of back pain to 9/10 intensity, with left lower extremity pain and numbness extending to the toes.  There was no loss of bowel or bladder control.  The CI’s baseline low back pain was 7/10.  On examination there was tenderness to palpation over the L2-L5 region.  The CI could forward flex fully, in order to tie his shoes.  No gait abnormalities were noted.  During the MEB examination (recorded on DD Forms 2807 and 2808) dated 28 February 2008, 3 months prior to separation, PE showed tenderness to palpation at the lumbar spine and limited ROM in all fields, with pain at the end point of ROM.  

At the 10 July 2008 VA Compensation and Pension (C&P) evaluation, performed 2 months after separation, the CI reported moderate daily pain described as an ache which lasted for hours. Radiating pain of a burning nature occurred bilaterally to the lower extremities down to the feet. PE showed a normal gait, with no assistive devices used for ambulation.  Forward flexion ROM was to 70 degrees, with combined ROM of 200 degrees.  Painful motion was noted; but no tenderness to palpation, spasm, guarding, abnormal spine contour, or incapacitating episodes. Lower extremity neurologic examination was normal.  Repetitive motion testing did not result in additional loss of motion, incoordination, lack of endurance, or fatigue.  

The Board directed attention to its rating recommendation based on the evidence.  The Army PEB rated the LBP 10%, analogously coded 5299-5237 (lumbar strain), citing total combined ROM, and referencing the VASRD General Rating Formula for Diseases and Injuries of the Spine. The VA did not service connect the low back pain, but did award vocational rehabilitation based on the CI’s spine disability.  In evaluating the evidence of record, the Board considered the VA examination to have significant probative value, since it was a thorough examination and was done just 6 weeks after the date of separation.  At that examination, forward flexion was 70 degrees, and thoracolumbar combined ROM was 200 degrees.  The Board agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees), and combined ROM (greater than 120 degrees but not greater than 235 degrees).  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes which would provide for a higher rating under that formula (for IVDS).  

The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The physical examinations proximate to separation showed no objective findings of radiculopathy that would impact duty performance.  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 was no evidence in this case that motor weakness existed to any degree that could be described as functionally impairing.  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 of the LBP condition.  

BOARD FINDINGS:  In the matter of the 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 20150511, 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

07 MAR 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170002596 (PD201500296)

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