ERECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01198
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060517

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Military Police, medically separated for “low back pain…with occasional left leg numbness and tingling,” with a disability rating of 10%.

CI CONTENTION:  The CI contends his back has worsened and also contends a heart condition.  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 - 20060413	VARD - 20061109	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain…with Occasional Left Leg Numbness and Tingling	5237	10%	Degenerative Disc Disease	5243	20%	20060727	
			Radiculopathy Left Lower Extremity Associated with Degenerative Disc Disease L4-5	8520	10%	20060727	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Low Back Pain…with Occasional Left Leg Numbness and Tingling.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in June 2003 after an airborne jump with a hard landing.  Magnetic resonance imaging (MRI) studies completed 3 February 2004 showed mild degenerative disc disease at L5-S1 with a small left paracentral disc protrusion.  The CI was deployed to Iraq from March 2004-March 2005 and sought medical treatment multiples times for his back pain.  Upon return he attended physical therapy (PT).  An orthopedic consult in February 2006 did not recommend surgery.  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 left leg radiculopathy for PEB adjudication.  

The MEB NARSUM examination on 6 March 2006, 2 months prior to separation, noted complaints of chronic low back pain, rated 6/10 with occasional left leg numbness.  Physical examination showed mild tenderness to palpation, normal strength, reflexes and sensory.  Straight leg raise testing was negative bilaterally.  There was pain with flexion and extension and minimal discomfort with rotation and side-to-side movement.  Thoracolumbar range of motion (ROM) measurements performed by PT on 7 March 2006 showed flexion of 60 degrees (normal 90) and a combined ROM of 185 degrees (normal 240) after repetition, limited by pain.  At the 27 July 2006 VA Compensation and Pension (C&P) evaluation, performed 2 months after separation, the CI reported back pain with left leg pain and numbness.  Physical examination noted spasms, but a normal gait.  Tenderness and mild lumbar flattening was noted.  The examiner stated that muscle spasm and localized tenderness or guarding were not severe enough to be responsible for abnormal gait or abnormal spinal contour.  Thoracolumbar ROM measurements showed flexion of 65 degrees (normal 90) and combined ROM of 205 degrees (normal 240) with painful motion.  Additional loss of flexion on repetitive motion was 55 degrees.  Motor strength and reflexes were normal.  Sensory examination noted decreased light touch and vibration along L4-5 nerve distribution.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5237 (lumbosacral strain), citing tenderness and a flexion of 60 degrees.  The VA rated the back condition 20% coded 5243 (intervertebral disc syndrome [IVDS]), based on the VA C&P examination 2 months after separation, citing forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees.  The VA also rated radiculopathy of the left lower extremity at 10%, coded 8520 (sciatic nerve, paralysis of, mild) citing decreased sense of vibration and light touch.  The Board agreed that a 20% rating, but no higher, was justified for the limitation of flexion (greater than 30 degrees but not greater than 60 degrees) reported on the MEB PT and VA examinations.  The Board considered whether a higher rating (§4.7) was achieved by using the alternate rating formula based on incapacitating episodes due to 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 CI had a small left paracentral disc protrusion at L5-S1 and there were symptoms of radiating pain documented in the treatment records; however, examinations indicated normal strength, reflexes and gait, and the sensory changes did not affect his job.  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 recommends a disability rating of 20% for the low back condition, coded 5237.  

BOARD FINDINGS:  In the matter of the low back condition, the Board unanimously recommends a disability rating of 20%, coded 5237 IAW 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	
Low Back Condition	5237	20%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150606, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB										

MEMORANDUM FOR Commander

20 MAR 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170001918 (PD201501198)

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