RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00461
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051105

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

CI CONTENTION:  The CI made no specific contention in her application.  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 - 20050921	VARD – No VA Claim	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5243	10%					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in March 2004 while deployed.  She sustained a jarring injury to her back when the tactical vehicle she was riding in hit a pot hole.  However, she did not seek medical attention for her injury until July 2004, when her condition had progressively worsened.  In August 2004 she started having numbness in her legs.  Radiographic studies revealed degenerative disc disease (DDD) of the lumbosacral spine.  Electrodiagnostic studies performed on 31 August 2004 were negative for radiculopathy.  She rejoined her deployed unit in October 2004.  Her back pain soon returned due to the weight of her protective vest.  Radiographic studies revealed lumbosacral disc protrusions without nerve compression.  Despite conservative treatment to include local epidural steroid injections, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and she was referred for an MEB.  The MEB forwarded “chronic low back pain” for PEB adjudication.

At an orthopedic clinic appointment on 19 July 2005, 4 months prior to separation, the CI reported decreased right leg and back pain with no complaint of weakness or radiating pain.  On examination she had normal strength, reflexes, and sensation.  She also had the ability to heel and toe walk.  There was no documentation of range of motion (ROM).  

During the MEB NARSUM examination on 24 August 2005, 2 months prior to separation, the CI reported continued back pain.  Physical examination revealed a slow and cautious gait.  There was tenderness about the muscles adjacent to the lumbar spine as well as decreased pinprick sensation over the right lower extremity.  Lower extremity strength was 4+/5 and reflexes were normal.  Thoracolumbar ROM was decreased in forward flexion of 80 degrees (normal 90) and extension of 15 degrees (normal 30).  There was no comment with regards to painful motion.  

The CI’s application indicated that she never underwent disability evaluation by the VA. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition at 10% coded 5243 (intervertebral disc syndrome), citing combined ROM of 222 degrees (normal 240); forward flexion to 80 degrees; and spinal tenderness.  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/or combined ROM greater than 120 degrees but not greater than 235 degrees as reported by physical therapy.  Although there was evidence of a “cautious” gait, a higher rating of 20% was not justified because there was no evidence of muscle spasm or guarding in any of the examinations proximate to separation.  There was no evidence of intervertebral disc syndrome (IVDS) which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula (for IVDS).  

The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  Although the CI indicated radicular pain and radiographic and electro-diagnostic studies supported some level of radicular nerve irritation or involvement, the PE’s proximate to separation revealed no objective findings of radiculopathy that would impact duty performance.  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 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, and 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 back condition.

BOARD FINDINGS:  In the matter of the back 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 modification or re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140725, 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, AR20170000116 (PD201500461)

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