RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00311
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050420

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Military Police, medically separated for “chronic subjective back pain,” rated 10%.

CI CONTENTION:  “Degenerative disc disease L5, S1, Radiculopathy Left Leg.”  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 - 20050307	VARD - 20050523	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Subjective Back Pain	5299-5237	10%	DDD	5299-5243	10%	STR	
			LLE Radiculopathy	8599-8520	Deferred	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Subjective Back Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in May 2004 after heavy lifting.  Radiographic studies showed broad base disk bulge at L5 with no spinal or thecal sac encroachment and degenerative disc disease (DDD).  At the time of orthopedic clinic appointment on 4 Jan 2005, the CI reported left lower extremity (LLE) paresthesia (tingling) and back pain.  She denied bowel or bladder dysfunction.  On examination, the CI had no back deformity and provocative testing for nerve root irritation was negative.  Testing for non-organic back pain was negative.  The CI had normal muscle strength and deep tendon reflexes, but light touch was decreased over the entire foot.  
The CI declined epidural steroid injections and surgery was deferred by orthopedics.  In PT the same day, she was noted to have slight weakness raising the left great toe and sensory loss of L3-S1.  Three weeks later, the motor function was normal, but the sensory changes persisted.  The reflexes were normal.  Despite treatment, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  The MEB forwarded “low back pain” for PEB adjudication.  At the MEB examination on January 2005, 3 months prior to separation, the CI reported numbness in her left leg due to her back injury.  The MEB NARSUM examination on 17 February 2005, 2 months prior to separation, noted complaints of discomfort and symptoms with minimal exertion.  The CI reported she was not able to perform the civilian equivalent of her assigned duties.  On examination, extremities were unremarkable.  No specific comment was made regarding the back or neurological examination.  No VA compensation and pension (C&P) examination was performed proximate to separation for the back.  An evaluation for a LLE radiculopathy was accomplished 28 December 2005, 8 months after separation.  It was not in evidence, but extensively cited in the 19 January 2006 VA rating decision.  The gait and stance were normal.  The neurological examination was normal and specifically noted no radicular deficit or muscle atrophy.  The range of motion (ROM) examinations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.  
Thoracolumbar ROM
(Degrees)	PT ~2 Mos. Pre-Sep	VA C&P~8 Months Post-Separation	
Flexion (90 Normal)	55	60	
Combined (240)	185	180	
Comments	Active		
§4.71a Rating	20%	20%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5299-5237 (analogous to lumbosacral or cervical strain), citing combined range of motion.  The VA also rated the back condition 10% coded 5299-5243 (analogous to intervertebral disc syndrome), based on Service Treatment Records (STR), citing limitation of forward flexion.  The Board agreed that a 20% rating, but no higher, was justified for limitation of active flexion at both the MEB and VA examinations.  There was no documentation of incapacitating episodes which would provide for a higher rating.  Although the CI experienced radiating pain, there was no objective evidence of a radiculopathy or functional impairment with a direct impact on fitness.  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 is no evidence in this case that there was radiculopathy with associated functional impairments sufficiently impairing to be separately unfitting.  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 back condition, coded 5299-5243.  

BOARD FINDINGS:  In the matter of the back condition and IAW VASRD §4.71a, the Board unanimously recommends a disability rating of 20%, coded 5299-5243.  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	
Chronic Subjective Back Pain	5243	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150515, with attachments
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

03 MAR 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170002599 (PD201500311)

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