RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00721
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051214

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E6, Radio Operator/Maintainer, medically separated for “low back pain” with a disability rating of 10%.  

CI CONTENTION:  “Review all conditions.”  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20051031	VARD – NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5299-5242	10%	No VA Exam in Evidence	
Polyneuropathy	Not Unfitting		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Back Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s condition began in 1994 as back pain and left thigh pain with exercise.  He sought treatment again in 1998.  In July 2003, while deployed to Operation Iraqi Freedom, the CI began to complain of severe low back pain with radiation to the left buttock and leg but he denied any specific injury or trauma.  Diagnostic imaging (MRI) studies 9 September 2003 while deployed showed herniated nucleus pulposus at L5-S1, with impingement on the left S1 spinal nerve root.  The CI returned to home station for further evaluation and treatment.  

Electrodiagnostic studies (EMG/NCV) performed on 1 April 2005 were negative for radiculopathy on the left side; however, there was evidence of an unrelated demyelinating polyneuropathy.  MRI studies 1 April 2005 showed no bulging or herniated intervertebral discs at any level.  There was no narrowing of the spinal canal or neuroforamina.  It appeared there was foci of abnormal signal intensity within the L1 and L3 vertebral bodies representing simple hemangiomas (collection of blood vessels).  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  

During the 29 July 2005 MEB NARSUM examination, 4 months prior to separation, the CI reported constant lower back pain with intermittent pain radiating into his left lower thigh rated as 5/10 and increasing to 9/10 with flare-ups.  The CI noted that prior to being activated for military service the pain impacted his ability to perform his civilian job.  The pain was aggravated by prolonged standing or walking.  He was unable to perform military duties that required him to lift more than 25 pounds without causing serious pain. The pain prevented him from performing the aerobic events of the physical fitness test and lower body weight training.  He was able to walk and swim at his own pace and distance.  The physical examination showed normal gait and reflexes.  There were left paralumbar muscle spasms with decreased sensation on the left anterior and posterior thigh down to the knee.  Provocative maneuvers for signs of radiculopathy or radiating pain due to spinal nerve root or sciatic nerve involvement were positive on the left but were negative on the right.  Thoracolumbar range of motion (ROM) measurements performed by physical therapy (PT) on 5 April 2005 showed flexion of 65 degrees (normal 90) and combined ROM of 180 degrees (normal 240), all limited by pain.  

The CI did not file a VA claim, therefore, there is no VA Compensation and Pension examination, or a VA rating decision determination.  The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic back pain condition 10%, analogously coded 5299-5242 (degenerative arthritis of the spine), citing degenerative disc disease without significant neurologic or electrodiagnostic abnormality.  

The panel agreed that a 10% rating, but no higher, was justified for the combined ROM (greater than 120 degrees but not greater than 235 degrees) reported on the MEB examination proximate to separation.  Although there was muscle spasm, it was not 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 also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI reported intermittent numbness to his left thigh; however the electrodiagnostic studies showed no evidence of radiculopathy.  There was evidence of polyneuropathy which is addressed below in the contended PEB condition section.  There was no evidence of intervertebral disc syndrome which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula for that condition. There was no evidence of an associated unfitting radiculopathy for consideration of a separate peripheral nerve rating.  

After due deliberation, and 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 condition.  

Contended PEB Condition:  Polyneuropathy.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the chronic back pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended polyneuropathy condition, the panel unanimously recommends no change from the PEB determinations as not unfitting.  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 20150602, w/atchs
Exhibit B.  Service Treatment Record

AR20170006561, 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,