RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01523
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20020219

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Lithographer, medically separated for “chronic low back pain,” with a disability rating of 10%.

CI CONTENTION:  Condition continues to worsen and negatively impacts daily activities.  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 - 20011203	VARD – 20020727 & 20030216	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5295	10%	Chronic Low Back Pain with Disc Protrusion at L5/S1	5293	10%	STR &
20021017	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP).  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back condition began in 2000 after repetitive heavy lifting.  The CI denied any specific injury or trauma.  Initial LBP with radiation into the legs later developed numbness and tingling into the posterior thighs, calves and great toe with left greater than right.  Diagnostic imaging (MRI) in March 2001 showed central disc protrusion with moderate canal narrowing at L5/S1.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “low back pain” for PEB adjudication.

The MEB NARSUM examination on 25 July 2001, 7 months prior to separation, noted complaints of continued 7-8/10 low back pain with exacerbation with activities.  Physical examination showed a non-tender back with tight lumbar paraspinal muscles.  Lower extremity strength, reflexes and sensation were normal.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated September 2001, 5 months prior to separation, the CI reported numbness and tingling in the left leg and toes.  Physical examination showed no back tenderness.  Back range of motion (ROM) was within normal limits.  Provocative testing (straight leg raise (SLR)) for radicular symptoms was negative.  Lower extremity strength, reflexes and sensation were normal.

At the 17 October 2002 VA Compensation and Pension (C&P) evaluation, performed 8 months after separation, the CI reported left lower back pain with occasional radiation into the left foot.  Physical examination showed normal gait and posture.  There was no muscle spasm, back tenderness, or deformity.  There was no evidence of radiculopathy or radicular symptoms on SLR testing.  ROM was flexion 80 degrees and combined ROM of 230 degrees with painful motion.  The CI ambulated normally and could toe and heel walk, hop, squat, and bear weight on each leg without evidence of back pain.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP condition 10%, analogously coded 5295 (lumbosacral strain), citing painful motion.  The VA also rated the LBP condition 10%, coded 5293 (intervertebral disc syndrome) based on the VA C&P examination 8 months after separation, citing painful motion.

In accordance with DoDI 6040.44, the Board is required to recommend a rating IAW the VASRD in effect at the time of separation, which was the 2002 VASRD standards for the spine.  The applicable coding options for this case are excerpted below:  

5292 Spine, limitation of motion of, lumbar
Severe ...................................................................................................................................... 40
Moderate ................................................................................................................................. 20
Slight ........................................................................................................................................ 10

5293 Intervertebral disc syndrome:
Pronounced; with persistent symptoms compatible with: sciatic neuropathy with
characteristic pain and demonstrable muscle spasm, absent ankle jerk, or other
neurological findings appropriate to site of diseased disc, little intermittent relief .............. 60
Severe; recurring attacks, with intermittent relief .................................................................. 40
Moderate; recurring attacks .................................................................................................... 20
Mild .......................................................................................................................................... 10
Postoperative, cured ................................................................................................................. 0

5295 Lumbosacral strain:
Severe; with listing of whole' spine to opposite side, positive Goldthwaite's sign,
marked limitation of forward bending in standing position, loss of lateral motion
with osteo-arthritic changes, or narrowing or irregularity of joint space, or some
of the above with abnormal mobility on forced motion ........................................................ 40
With muscle spasm on extreme forward bending, loss of lateral spine motion, unilateral,
in standing' position ................................................................................................................ 20
With characteristic pain on motion.......................................................................................... 10
With slight subjective symptoms only........................................................................................ 0

There was no evidence that lumbar ROM was limited greater than “slightly” for any higher alternative rating under code 5292, and no evidence of lumbar spine spasm or abnormal motion for any higher rating under code 5295.  The CI did have intervertebral disc syndrome with persistent symptoms compatible with sciatic neuropathy (radiculitis) and the Board considered rating under code 5293 rather than a separate lumbar spine and separate sciatic rating; however, there was insufficient evidence that the CI’s disability picture approximated the 20% rating criteria listed above, and alternative coding under 5293 would offer no benefit.  There was no documentation or evidence of ratable peripheral nerve impairment (no focal neurologic deficits) which would provide for additional rating.  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 LBP 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 20150612, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170006626, 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