RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00697
BRANCH OF SERVICE:  army	SEPARATION DATE:  20050908

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Unit Supply Specialist, medically separated for “chronic back pain,” with a disability rating of 0%.  

CI CONTENTION:  “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 - 20050708	VARD - 20060221	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5237	0%	Muscle Spasm, Lumbar Spine…	5237	10%	20051119	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:  

Chronic Back Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in July 2002 after lifting heavy inventory.  The CI denied any trauma.  Radiograph studies (MRI) dated October 2004 documented a bulging intervertebral disc at the L4-L5 level.  At a neurology clinic visit in June 2004, the CI reported lower back pain with occasional pain radiating to the left gluteal and left hip region.  Pain was aggravated by activity.  The CI denied weakness, loss of sensation, or bowel/bladder dysfunction.  On physical examination range of motion (ROM) was normal, testing for sciatic nerve irritation was negative, and strength and reflexes were normal throughout.  No surgical intervention was recommended.  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 MEB.  The MEB forwarded “degenerative disc disease and probable facet mediated back pain unresponsive to all conservative treatment” for PEB adjudication.  

At the MEB examination on 19 April 2005 (5 months pre-separation, the CI reported continued pain.  Physical examination showed tenderness of the left lumbar paraspinous muscles with spasms, and painful ROM.  Gait was not addressed.  

At the MEB NARSUM examination dated 3 May 2005 (4 months prior to separation), the CI reported pain occurring 3 to 4 times per week with occasional radiation into the left buttock; and aggravated by lifting more than 20 pounds, speed-walking, running, sit-ups, and wearing protective gear.  Physical examination showed a forward flexion of the thoracolumbar spine at 40 degrees (normal 90) with no change after repetition, and pain noted with all ROMs.  

At the 19 November 2005 VA Compensation and Pension (C&P) evaluation (2 months after separation), the CI reported constant pain radiating to the left, that increased with prolonged walking or standing, and denied flare-ups or incapacitating episodes.  Physical examination showed a normal gait, normal curvature, no evidence of spasm or signs of nerve root irritation, and forward flexion to 80 degrees with no further decreases in ROM after repetition.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB rated the back condition 0%, coded 5237 (lumbosacral or cervical strain), citing left paraspinal tenderness with muscle spasm.  The VA rated the back condition 10% coded 5237 (lumbosacral or cervical strain), based on the VA C&P examination 2 months after separation, citing limitation of forward flexion not greater than 85 degrees.  The Board deliberated the probative value of the examinations in evidence and the totality of the record.  The Board agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees) reported on the May 2005 MEB NARSUM examination.  The NARSUM examiner used repetitive measurement to arrive at 40 degrees of forward flexion.  Despite specifying that ‘thoracolumbar’ measurements were obtained using an ‘inclinometer,’ the measurements seemed more consistent with goniometric measurements, and therefore supported a 20% rating based on a forward flexion of 40 degrees.  Although the CI experienced radiating pain, there was no objective evidence of a radiculopathy or functional impairment with a direct impact on fitness.  While the CI may have experienced radiating pain from the back condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  There is no evidence in this case that there was radiculopathy with associated functional impairments separately functionally impairing.  The Board therefore concludes 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 back condition, coded 5237.  

BOARD FINDINGS:  In the matter of the back condition, the Board majority recommends a disability rating of 20%, coded 5237 IAW VASRD §4.71a.  The single voter for dissent recommended a modification to 10% and did not elect to submit a minority opinion. 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	
Degenerative Disc Disease, L3-L4 and L4-L5	5237	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150603, 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 
XXXXXXXXXXXXXXXXXX, AR20170000054 (PD-2015-00697)

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, I reject the Board’s recommendation and accept the minority opinion to modify the individual’s disability rating to 10% without recharacterization 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