RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01036
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040615

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Electronic Device Repairer, medically separated for “chronic low back pain (LBP)…,” with a disability rating of 20%.  

CI CONTENTION:  The CI contended he was still extremely limited and his quality of life was affected as a result of his injuries to his elbows, wrists, shins and knees.  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 - 20040412	VARD - 20041119	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP…	5243	20%	Lumbosacral Strain with History of Herniated Nucleus Pulposus	5237	10%	20040910	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.   According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s condition began in February 2001 during AIT.  The MEB forwarded “chronic LBP secondary to lumbar radiculopathy due to disc herniation at L4-5” for PEB adjudication.  Diagnostic imaging (MRI) completed in December 2001 and August 2003 showed L4-5 disk herniation with a central protrusion indenting the thecal sac.  The MEB NARSUM examination on 18 February 2004, approximately 4 months prior to separation, noted that the CI had complaints of constant dull, throbbing LBP with occasional flare-ups of sharp, stabbing pain that radiated into his left hip and buttock. Treatment with physical therapy (PT), narcotic pain medications, epidural steroid injections, and an electrical stimulator (TENS) had not been effective.  There were functional limitations of an inability to do any physical training with an inability run, jump, or march.  The physical examination showed tenderness to palpation over the lumbar spine radiating down into the left buttock and hip area.  Sensation and reflexes were normal.  There was a positive straight leg raise (for radicular signs) on the left side at about 45 degrees.  The CI also “does exhibit some difficulty bending over.”  ROM was reported as flexion 21 degrees (normal 90), extension 6 degrees (normal 30), right side bending 11 degrees (normal 30), and left side bending 17 degrees (normal 30).  The PT ROM testing on 23 March 2004, approximately 3 months prior to separation, provided the same precise values as listed in the NARSUM.  

At the 10 September 2004 VA Compensation and Pension (C&P) evaluation, performed approximately 3 months after separation, the CI reported chronic LBP with functional limitations of an inability to run.  The physical examination showed a normal gait with heel and toe gait normal.  There was no tenderness.  Reflexes and sensation were normal.  ROM was normal in all planes to VASRD limits (flexion 90 degrees/combined 240 degrees) with pain on repetition.  At the 20 January 2005 C&P evaluation, performed approximately 7 months after separation, the CI reported continued chronic LBP with radiation of pain down his left leg.  He could not sit or walk for too long.  Physical examination showed a normal gait with normal motor, sensor, and reflex examinations.  There was tenderness without muscle spasm.  ROM was painful with flexion to 90 degrees/combined 240 degrees (normal).  MRI in April 2005 showed degenerative disc disease at L3 thru S1 and a bulging disc with significant disc protrusion at L4-5 which appeared to contact the exiting L5 nerve root and likely correlated with the L5 radiculopathy symptoms.  An X-ray study done in May 2005 showed mild degenerative disc disease at L4-5 and L5-S1.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic LBP condition 20%, coded 5243 (intervertebral disc syndrome), citing reduced ROM attributed to pain and rating as intervertebral disc syndrome under the VASRD general rating formula for thoracolumbar spine.  This was likely application of AR 635-40 in effect at the time.  The VA rated the “Lumbosacral Strain…” condition 10% coded 5237 (Lumbosacral strain), based on the VA C&P examination approximately 3 months after separation, citing pain on repetitive motion.  In assigning probative value to these somewhat conflicting examinations, the Board noted that the limitation of thoracolumbar flexion (20 degrees) reported in the MEB NARSUM/PT examination  suggested consideration of the next higher rating of 40%; however, the examination did not measure all planes of motion, specify which spine segment was measured, or address repetition.  The preponderance of the STR entries and the proximate post-separation VA examinations all documented ROMs that were not nearly as limited and would not support any rating higher than the 20% awarded by the PEB.  The Board adjudged that the MEB NARSUM/PT ROM values were an outlier that was not representative of the CI’s disability picture proximate to separation.  All other examinations in evidence would not support any rating higher than the 20% awarded by the PEB.  

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).  Diagnostic imaging studies supported some level of radicular nerve irritation or involvement, but physical examinations (treatment notes, PT, MEB NARSUM, and VA C&P) proximate to separation revealed no objective findings of radiculopathy that would impact duty performance.  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.  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 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 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 chronic 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 20150604, 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

08 MAR 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170001077 (PD201501036)

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