RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00652
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051218

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Multiple Launch Rocket System Operations/Fire Direction Specialist, medically separated for “chronic back pain without neurologic abnormality,” with a disability rating of 10%.

CI CONTENTION:  “Review all conditions.”  The 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 - 20050927	VARD - 20060214	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain without Neurologic Abnormality	5299-5237	10%	Chronic Strain Thoracolumbar Spine	5237	20%	20051026	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Back Pain without Neurologic Abnormality.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic back pain without neurologic abnormality began in January 2004 after heavy lifting and running.  The CI denied any specific injury or trauma.  Diagnostic imaging (X-ray) studies 9 July 2004 showed spina bifida occulta at S1, with no other bony abnormality noted.  There was normal spinal curvature.  Diagnostic imaging (MRI) studies on 26 October 2004 revealed no abnormalities, no bulging discs, foraminal stenosis, or nerve root impingement at any level.  Diagnostic imaging (X-ray) studies on 24 August 2005 showed a normal thoracolumbar spine with no compression deformity or bony fracture.  There were no significant degenerative changes noted.  Diagnostic imaging (X-ray) studies 26 October 2005 revealed minimal dextroscoliosis with a spina bifida occulta at S1.  There was no spondylosis or degenerative disc space narrowing.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.

During the 30 August 2005 MEB examination, 4 months prior to separation, the CI reported low back pain with muscle spasms, but without motor sensory deficits.  The pain prevented him from lifting, carrying, and sitting for prolonged periods (including driving).  The pain was relieved by medication (Motrin and past use of muscle relaxants, narcotics, and Ultram).  Physical examination showed no tenderness, muscle spasms or motor sensory deficits.  Thoracolumbar repetitive range of motion (ROM) was flexion to 90 degrees (normal) and a combined ROM of 210 degrees (normal 240) mildly limited by pain.

At the 26 October 2005 VA Compensation and Pension (C&P) evaluation, performed 2 months before separation, the CI reported constant lower lumbar pain that radiated up his back to his shoulders, rated 7/10.  The pain was aggravated by physical activity and prevented him from running.  The pain was relieved by rest and medication (Valium, Flexeril, Motrin, and Ultram).   Physical examination showed normal gait.  There was paravertebral tenderness and muscle spasms of the thoracolumbar musculature.  Straight leg raise testing was negative bilaterally.  Thoracolumbar ROM was limited by pain to 60 degrees forward flexion and combined ROM to 165 degrees.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic back pain without neurologic abnormality condition 10%, analogously coded 5299-5237 (lumbar spine strain), citing painful limited motion with muscle spasms.  The VA rated the chronic back pain without neurologic abnormality condition 20%, also coded 5237, based on the C&P examination 2 months before separation, citing limitation of forward flexion.

Although the VA examination evidenced limitation of thoracolumbar forward flexion to 60 degrees which met criteria for a 20% rating, the preponderance of the STR evidence demonstrated insufficient limitation of motion to support a 20% rating.  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 panel agreed a 10% rating was justified for the presence of painful motion, tenderness, and spasm.

The panel 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 panel’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 panel 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 panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the chronic back pain without neurologic abnormality condition.

BOARD FINDINGS:  In the matter of the chronic back pain without neurologic abnormality condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150605, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170006542, XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					       
						      					
Enclosure