RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00677
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070205

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Armor Crewman, medically separated for “low back pain [LBP],” with a disability rating of 10%.  

CI CONTENTION:  The CI’s condition continues to worsen and negatively impacts daily activities.  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 - 20061103	VARD - 20070326	
Condition	Code	Rating	Condition	Code	Rating	Exam	
LBP	5299-5237	10%	Lumbar Herniated Disc	5239	10%	20070112	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

LBP.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in March 2004 without any specific injury or trauma.  An MRI showed degenerative disc disease (DDD) at multiple levels with possible nerve root impingement.  The CI was referred to physical therapy (PT), but his pain persisted.  In the spine clinic on 27 April 2006, 9 months prior to separation, he was noted to have a normal gait and neurological examination with near full range of motion (ROM).  The CI was referred to physical medicine for electrodiagnostic studies which were normal on 8 August 2006, 6 months prior to separation.  The physical examination showed a normal gait and neurological examination with flexion of 80 degrees (normal 90).  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 a MEB. The MEB forwarded LBP for PEB adjudication.  The 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)	Spine Clinic ~10 Mos. Pre-Sep	PT~5 Mos. Pre-Sep	VA ~ 1 Mos. Pre-Sep	
Flexion (90 Normal)	“Range of motion of the lumbar spine is near full…”	60	70	
Combined (240)	240	145	220	
Comments	Painful motion	Painful motion	Painful motion; Tenderness	
§4.71a Rating	10%	20%	10%	

The MEB NARSUM examination on 6 September 2006, 5 months prior to separation, noted complaints of daily back pain which interfered with activities of daily living.  The physical examination showed a normal gait, no palpable back spasm and a normal neurological examination.  The ROM was noted to be near full in the discussion, but the (undated) values from PT were reduced and are charted above.  

At the VA Compensation and Pension (C&P) evaluation, performed on 12 January 2007 (it was dated 12 January 2006, but this is clearly an error based on all the other evidence), a month before separation, the CI reported stiffness and weakness in his lower back and constant pain that radiated down both legs.  The physical exam showed painful motion, tenderness, no ankylosis or rigidity, no muscle spasms and no intervertebral disc syndrome (IVDS).  X-rays were normal.  The posture, gait, and neurological examination were normal.  An MRI on 8 February 2007 showed multi-level DDD with possible impingement of the left and right S1 nerve roots.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back pain 10%, analogously coded 5237 (lumbosacral strain), citing ROM limited by pain and slight tenderness.  The VA also rated the back pain 10% coded 5239 (spondylolisthesis or segmental instability), based on the VA C&P examination a month before separation, citing a forward flexion of 60 degrees but not greater than 85 degrees.  The Board agreed 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 spine and VA examinations proximate to separation.  The flexion recorded on the undated PT examination supports a 20% rating; however, it is an outlier from the other examinations.  The VA examination is the most proximate to separation and is used for rating purposes.  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.  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).  There was no evidence of an associated unfitting radiculopathy for consideration of a separate peripheral nerve rating.  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 back condition.  

BOARD FINDINGS:  In the matter of the 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 20150602, 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, AR20160019462 (PD201500677)

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