RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00322
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070430

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

CI CONTENTION:  “VA rated me at 90% - request to be medically retired.”  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 - 20070321	VARD - 20080702	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain 	5237	10%	Lumbosacral Strain 	5243	20%	20080616	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to the service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back pain (LBP) began in July 1997 after a parachute landing fall.  Initially, there was extending pain into his legs.  Within 3 months after this injury, he recovered and was “pain-free.”  In August 2002, he again participated in airborne operations which resulted in severe LBP.  Diagnostic imaging studies revealed mild degenerative disc disease at L5-S1 as well as multi-level bulging discs of the lumbosacral spine.  Surgical intervention was not initially indicated, but later offered and the CI declined.  Conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic LBP multi-level spondylitic disease, most remarkable at L4-5 and right radiculopathy” for PEB adjudication.

During the MEB examination dated 10 February 2007, 3 months prior to separation, the CI reported 4/10 LBP with a marked increase when performing high-impact activities to include running, prolonged standing, performing sit-ups, and wearing combat gear.  Physical examination revealed lumbar tenderness.  Although thoracolumbar range of motion (ROM) was limited by pain, a measured range was not documented.  Strength, reflexes, and sensation were normal.  

At an MEB neurosurgery specialty examination conducted on the same day as noted above,  the CI reported LBP with radiating pain down both legs (right greater than left).  Physical examination showed tenderness about the lumbar spine and decreased touch sensation over the inner side of the right foot as compared to the left foot.  Distal reflexes and strength were normal and no muscle spasms were present.  The provider documented trunk flexion with fingers reaching to 28 centimeters (11 inches) from the toes, which approximates 70-80 degrees of thoracolumbar flexion (normal 90).  

At the 16 June 2008 VA Compensation and Pension (C&P) evaluation, performed 14 months after separation, the CI reported bilateral LBP rated 6/10 scale, with occasional extension of pain down both legs (right greater than left).  He reported no weakness, stiffness, fatigability or decrease in endurance.  Physical examination showed normal posture, spinal contour, strength, reflexes, and sensation.  Straight leg raise testing was negative for radiating symptoms.  Thoracolumbar ROM was decreased at 45 degrees of flexion and 10 degrees of extension (normal 30) and was limited by pain after repetition.   

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back pain condition at 10%, coded 5237 (lumbar strain), citing painful limited motion.  The VA rated the back condition at 20% coded 5243 (intervertebral disc syndrome), based on the VA C&P examination 14 months after separation, citing limitation of forward flexion.  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) reported on the MEB NARSUM examination 3 months proximate to separation.  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.  

The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The presence of functional impairment with a direct impact on fitness is the key determinant in the Board’s decision to recommend any condition for rating as additionally unfitting.  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 CI reported symptoms of radiating pain documented in the treatment record; however, examinations indicated normal strength, reflexes and gait, and the sensory changes did not affect his job.  Radiographic studies did not support any level of radicular nerve irritation or involvement, and physical examinations (PT, MEB and NARSUM) proximate to separation revealed no objective findings of radiculopathy that would impact duty performance.  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 concluded that there was insufficient cause to recommend a change in the PEB adjudication for the chronic LBP condition.

BOARD FINDINGS:  In the matter of the chronic LBP 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 20150519, w/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

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160018679 (PD201500322)

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