RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01307
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050531

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Cannon Crewmember, medically separated for “chronic low back pain…,” with a disability rating of 10%.

CI CONTENTION:  His condition continues to worsen and impact his 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 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 - 20050322	VARD - 20051128	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain…	5299-5242	10%	Lumbosacral Degenerative Disc Disease	5243	20%	20050711	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI suffered an initial back injury in 1998 with atraumatic worsening (or recurrence) in approximately March of 2004.  There was intermittent documentation of bilateral radicular symptoms, with no indication of subjective weakness; and, this was corroborated by the neurological examinations in outpatient entries.  Diagnostic imaging (MRI) demonstrated “mild” bi-level degenerative disc disease (L4-S1 with “mild” central thecal impingement at L5/S1, but no nerve root encroachment at either level).  There was measured range of motion (ROM) evidence from some physical therapy (PT) entries that recorded flexion in the 60-70 degree range (normal 90), and no entries that reflected more significant ROM limitation.  There was STR documentation of normal gait, with no contrary entries; no STR evidence for abnormal spinal contour; and, no STR documentation of incapacitating episodes.  Surgery was not recommended; conservative treatment did not result in sufficient improvement to allow unrestricted duty; and, the CI was referred for an MEB.  The MEB forwarded “low back pain” [MEB diagnosis] for PEB adjudication.   

The NARSUM examination on 28 February 2005 (3 months prior to separation) documented constant pain that “stays mostly in his lower back but can radiate to his upper thighs” and was rated “6/10 severity which increases to 10/10 severity with exercise or movements.”  The physical examination recorded tenderness without note of other findings.  There was no neurological examination documented in the NARSUM, although a contemporary STR entry by the same examiner documented 5/5 motor strength but “decreased light touch sensation over L4 L5 dermatome.”  The MEB’s DD Form 2808 physical examination recorded grossly normal neurologic findings.  The NARSUM referenced ROM measurements by PT from 2 weeks earlier that recorded flexion to 35 degrees (normal 90) with a combined ROM of 145 degrees (normal 240).

A VA Compensation and Pension (C&P) examination of 11 July 2005 (2 months after separation) documented baseline pain rated 4/10 with flares to 7/10 precipitated by bending and prolonged standing or walking, and noted the use of a cane with walking limited to 20 feet during severe flares; although, the CI was employed as a civilian artillery range control officer at the local Army base.  The VA examiner also noted bilateral leg radiation and sensory symptoms, but there was no mention of motor symptoms.  The physical examination recorded a normal gait and spinal contour, no tenderness (but pain with percussion), and normal neurological findings (5/5 strength, intact sensation, symmetric reflexes).  The measured ROM was flexion to 35 degrees (after 5-degree DeLuca deduction for loss with repetition) and combined ROM of 145 degrees (175 degrees before DeLuca deductions).  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating under code 5299-5242 (analogous to degenerative arthritis of the spine) cited ROM “limited by pain”. The VA’s rating under code 5243 (intervertebral disc syndrome), referencing the C&P ROM evidence, cited the VASRD §4.71a 20% criterion of “flexion ... greater than 30 degrees but not greater than 60 degrees.”  The Service ROM evidence was equivalent, thus members agreed that all of the probative ROM evidence at separation justified a 20% recommendation under the same §4.71a criterion.  The Board also considered if additional service 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.  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).”  The intermittently documented sensory impairment had no functional implications, and there was no objective evidence of motor weakness.  There was thus no evidence for peripheral nerve involvement that would have logically impacted military occupation-specific activities.  The Board therefore concluded that additional service 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 lumbar spine condition, preferring code 5242.   

BOARD FINDINGS:  In the matter of the lumbar spine condition, the Board unanimously recommends a disability rating of 20%, coded 5242 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	
Chronic Low Back Pain	5242	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150615, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB										

MEMORANDUM FOR Commander

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXXX, AR20170002467 (PD201501307)

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