RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01442
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060825

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

CI CONTENTION:  The CI contended for his back condition as well as his shoulder and knee problems.  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 - 20060622	VARD - 20120406	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5242	10%	Herniated Disc	5237	NSC	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NSC	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.    According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic low back pain (LBP) condition began in approximately 1996-1997 after heavy lifting.  Magnetic resonance imaging (MRI) of the lumbosacral spine performed on 23 March 2004 showed degenerative disc changes and a broad-based disc protrusion at L4/L5 vertebra which caused narrowing of the right neural foramen and compression on the nerve root.  No surgery was recommended by three orthopedic surgeons.  A subsequent MRI in June 2005 confirmed a broad based right side bulging disc with compromise of the right-sided neural foramen at L4/L5 vertebra.  At the pain management clinic examination on 10 January 2006, 8 months prior to separation, the CI reported constant dull achy LBP at an intensity level of 6/10, which increased in intensity with exertion.  He reported the radiating pain to both lower extremities (LE) present during deployment had resolved.  Physical examination showed c gait, with ability to forward flex his hands below the knee to mid leg level (fingers between mid-shin and ankles (approximately 70-80 degrees), with painful motion.  The examiner recorded “good extension without pain,” no difficulty or limitation of motion with rotation or lateral flexion.  There was tenderness noted at L2/L3 vertebra.  Lower extremity strength, sensation, and reflexes were normal.  The MEB forwarded “degenerative disc disease of the lumbar sacral spine” and “bilateral spondylolysis of the L4 vertebra” for PEB adjudication.

The MEB NARSUM examination on 29 March 2006, 5 months prior to separation, noted complaints of central non-radiating LBP with no neurologic symptoms in the LE.  The CI described the pain as constant.  Physical examination showed forward flexion to 82 degrees (normal 90), and combined ROM of 215 degrees (normal 240).  The CI could heel walk and toe walk without difficulty.  Lower extremity strength, sensation, and reflexes were normal and straight leg raising to elicit radicular symptoms was positive for back pain bilaterally.  

There was no VA Compensation and Pension (C&P) evaluation performed within 12 months of separation.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic LBP condition 10%, analogously coded 5299-5242 (degenerative arthritis of the spine), citing forward flexion to 82 degrees without neurologic deficit.  The original VA rating decision (VARD), dated 17 January 2012 (over 5 years post separation) did not service connect the low back condition because the CI did not attend a scheduled VA C&P examination in March 2011.  The VARD in April 2012 continued the NSC determination due to lack of available evidence.  
  
The Board agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) or combined ROM (greater than 120 degrees but not greater than 235 degrees) reported on the physical therapy and NARSUM examinations proximate to separation.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes which would provide for a higher rating under that formula (for IVDS).  Although the CI experienced radiating pain to the LE from the low back condition, this resolved after his return from deployment.  There was no objective evidence of a radiculopathy with functional impairment (such as weakness) that directly impacted fitness for duty.  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 chronic low back pain condition.    

BOARD FINDINGS:  In the matter of the chronic low back pain 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 20150618, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170006597, XXXXXXXXXXXXXXXXXX 

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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,					       
						      					
Enclosure