RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00488
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060721

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

CI CONTENTION:  “Please review 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 - 20060623	VARD - 20060921	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5299-5237	10%	L5-S1 Herniated Disc	5299-5242	20%	20060726	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:

Chronic Back Pain.   According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was recovering from a 2003 back injury when it was re-injured in an August 2004 blast injury while deployed to Iraq.  After the deployment he complained of persistent back pain with right leg radiation; and, diagnostic imaging (MRI) demonstrated disc disease (spondylosis [degenerative changes of vertebral attachment processes], and right L5/S1 herniation).  The available outpatient STR evidence that was probative to functional impairment, range of motion (ROM), and other VASRD rating criteria was consistent with that from the NARSUM and VA examinations which follow.  There was STR documentation of normal neurological findings, with no entries to the contrary; and, there was no documentation of incapacitating episodes.  Surgery was not recommended; conservative treatment did not result in sufficient improvement to allow unrestricted duty; and, the CI was referred for MEB which in turn forwarded “lumbar spondylosis” to the PEB.

The MEB NARSUM examination in June 2006 (5 weeks before separation) documented “constant” back pain with right leg radiation (sensory but no subjective motor complaints) that was aggravated by prolonged sitting or standing and prohibited running and load bearing.  Physical examination recorded normal neurological findings (5/5 strength, intact sensation).  Formal ROM measurements for the MEB were conducted by physical therapy in May 2006 (9 weeks before separation), and documented flexion to 40 degrees (normal 90) and combined ROM of 170 degrees (normal 240).

A VA Compensation and Pension (C&P) examination in July 2006 (5 days after separation) documented “significant” back pain with right leg radiation (no mention of sensory or motor complaints) that was aggravated by bending and lifting, limited walking to 15 minutes, and prohibited running.  Physical examination recorded a “limping” gait, the absence of spasm, and normal neurological findings (motor, sensory, reflexes).  Measured ROM was flexion to 40 degrees (incorporating 10 degree DeLuca deduction for loss with repetition) and combined ROM of 135 degrees.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back pain condition 10%, analogously coded 5299-5237 (lumbosacral strain), tenderness and pain limited motion.  The VA rated the back pain condition 20%, analogously coded 5299-5242 (degenerative arthritis of the spine), based on the C&P examination 5 days after separation, citing limitation of motion further reduced by DeLuca criteria.  The Board agreed the STR and VA evidence support a 20% rating based on limitation of forward flexion.  There was no documentation of incapacitating episodes or diagnosis of intervertebral disc syndrome that supports a higher rating under that formula.

The Board also considered if additional 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 §4.71a general rating formula for the spine, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  The intermittently documented sensory symptoms were of no significant functional consequence and without objective findings, and there were no subjective or objective motor deficits.  Members therefore agreed that a functional link to fitness was not sufficiently established, and 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 lumbar spine condition, preferring code 5242.

BOARD FINDINGS:  In the matter of the lumbar spine condition, the Board unanimously recommends a disability rating of 20%, coded 5242 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 the prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Spondylosis and Disc Disease, Lumbar Spine	5242	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150526, 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 XXXXXXXXXXXXXXXXXXXXX, AR20160018722 (PD201500488)

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