RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00726
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060424

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, CI Agent, medically separated for “chronic radiating low back pain” with a disability rating of 10%.  

CI CONTENTION:  The CI contends his back condition continues to worsen and negatively impact 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 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 - 20060602	VARD - 20150602	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Radiating Low Back Pain…and No Clinical Signs of Radiculopathy	5243	10%	Lumbar Strain		10%	STR	
			Left Lower Extremity Sciatica		10%		
			Right Lower Extremity Sciatica		10%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Radiating Low Back Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in February 2004 after falling during a dismounted battle drill at PLDC [Primary Leadership Development Course].  Magnetic resonance imaging (MRI) studies on 7 February 2005 showed paracentral extruded disc at L5-S1 and left disc protrusion at L4-L5 and degenerative disc disease.  A bone scan in March 2005 was reported as normal.  At the time of the orthopedic clinic appointment on 6 May 2005, the CI reported low back pain (LBP) with pain radiating to the left lower extremity (LLE).  The CI reported no relief from epidural injections or medication (Neurontin).  On examination there were no muscle spasms or guarding and gait was normal.  The CI had tenderness to palpation (TTP), normal range of motion (ROM), and normal strength, sensation and reflexes.  At the 22 December 2005 Family Practice clinic appointment, the CI reported LBP with episodes of numbness of left toes which was treated with epidural steroid injections (ESI) and the numbness resolved.  On examination there were no muscle spasms or TTP.  Reflexes and sensation were normal and the CI was able to toe and heel walk.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty. The MEB forwarded “chronic low back pain with radiculopathy from L4-L5, L5-S1 disc bulge” for PEB adjudication.  At the MEB examination on 22 December 2005, 4 months prior to separation, the examiner noted the CI was able to bend to knee level (approximately 45 to 60 degrees – normal for forward flexion 90 degrees) and had straight leg testing was positive bilaterally.  The MEB NARSUM examination on 22 January 2006, 3 months prior to separation, noted complaints of increasing chronic LBP radiating down the LLE to the thigh, with some numbness and tingling in the toes and feet.  The physical examination showed a normal gait with minor TTP of the muscles.  Strength, reflexes and sensation were normal and straight leg raise testing was negative.  Low back ROM was flexion of 50 degrees (90 normal) and a combined ROM of was incomplete.  There was no VA C&P examination performed within 12 months of military separation.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5243 (intervertebral disc syndrome), citing some paraspinal muscle tenderness with a normal gait and ROM limited by pain.  The original VA Rating Decision (VARD) was dated 2 June 2015 and cited STR and VA treatment notes from late 2014. The VARD rated the back condition 10%, citing ROM of flexion greater than 60 degrees and combined ROM greater than 120 degrees, with an effective date of 30 April 2014 (eight years after separation) citing combined ROM of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; forward flexion greater than 60 degrees and localized tenderness not resulting in abnormal gait or abnormal spinal contour.  The VA further cited painful motion and no incapacitating episodes during the past 12 months.  The VA also rated the left lower extremity sciatica and the right lower extremity sciatica each 10% for mild incomplete paralysis.
  
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 MEB DD Form 2808 and MEB NARSUM examinations.  The Board noted the original VA rating was too remote from the date of separation to have any probative value for the Board’s rating recommendation for the disability at the time of separation.  The Board considered whether a higher rating (§4.7) was achieved by using the alternate rating formula based on incapacitating episodes due to intervertebral disc syndrome (IVDS).  Although the CI had intervertebral disc disease, there were no incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula (for IVDS).  The Board 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 Board’s decision to recommend any condition for rating as additionally unfitting.  The CI had symptoms of radiating pain documented in the treatment records as well as paresthesia of the LLE; however, examinations indicated normal lower extremity strength, sensation, and reflexes.  Radiating pain is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates)” and there was no evidence in this case that motor weakness or sensory deficit existed to any degree that could be described as functionally impairing.  The Board 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 Board recommends a disability rating of 20% for the low back condition, coded 5243.  

BOARD FINDINGS:  In the matter of the radiating low back pain condition, the Board unanimously recommends a disability rating of 20%, coded 5243IAW 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	
Radiating Low Back Pain Condition	5243	20%	

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 
XXXXXXXXXXXXXXXXXX, AR20170000070 (PD201500726)

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