RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01618
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050715

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an National Guard E4, Heavy Wheeled Vehicle Mechanic, medically separated “chronic low back pain…” with a disability rating of 10%.

CI CONTENTION:  The CI requested a review of all conditions.  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 - 20050614	VARD - None	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain…	5237	10%	No VA Examination in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:

Chronic Lower Back Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back condition began in Iraq in the spring of 2004 while unloading tires.  He was evaluated by neurosurgery and there was concern for herniated disc at L5-S1.  The CI was medically evacuated for further evaluation.  A neurology evaluation in May 2004 diagnosed lumbosacral myofascial pain and left sciatica.  Serial physical medicine evaluations in record noted positive testing for radicular pain and one evaluation in February 2005 noted an antalgic gait and pain with decreased flexion and extension.  The CI had epidural steroid injections with improvement in the left lower extremity pain, but minimal improvement in the back pain.  Diagnostic imaging (MRI) in September 2004 revealed foraminal stenosis with disc bulge with “tiny” central disc protrusion and arthritis.  A physical medicine examination on 21 March 2005, 4 months before separation, noted complaints of low back pain with forward flexion with radicular pain in the [left] lateral foot.  There was no persistent numbness, tingling, or weakness and electrodiagnostic studies were normal.  Despite physical therapy and multiple pain reducing injections the CI’s condition did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic low back pain secondary to lumbar spondylosis and degenerative disc disease” for PEB adjudication.

An orthopedic MEB consult on 21 March 2005, 4 months prior to separation, noted complaints of low back pain, aggravated by activity and greatest with forward flexion which caused radiating pain into the left leg.  He denied bowel or bladder problems, persistent weakness, numbness or tingling.  Physical examination was “essentially within normal limits”, except for pain with forward flexion, mild left SI joint tenderness, and positive bilateral testing for sacroiliac joint pain.  Strength, sensation and reflexes in bilateral lower extremities were intact.  No surgery was recommended.  The permanent profile dated 25 March 2005 profile, 4 months before separation, indicated the CI could walk or bike for the APFT.

The MEB NARSUM examination on 29 April 2005, 3 months prior to separation, noted the same low back and left lower extremity complaints as the orthopedic MEB consult exam.  Physical examination revealed spinal tenderness with negative straight leg raise testing, with mild left sciatic notch tenderness.  Back range of motion (ROM) measurements and painful motion were not addressed.  The examiner noted multiple pain responses to exam maneuvers not anticipated to elicit pain.  The CI was able to heel-toe walk, but complained of low back pain while duck walking (walk in squatting posture).  Neurological testing noted slight decreased left lateral calf sensation.  The MEB NARSUM examiner noted the MRI above showed posterior disc bulges and likely annular ligament tears, with findings most significant at L5-S1 with disc bulge and arthritis causing minimal symmetrical neuroforaminal stenosis.  During the MEB physical therapy examination on 3 May 2005, also 3 months prior to separation, physical examination revealed thoracolumbar repetitive ROM of flexion 30 degrees (normal 90) and combined ROM 155 degrees (normal 240) and the therapist indicated it  ROM was limited by pain.  There was no VA Compensation and Pension evaluation for the Board to review.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back pain condition 10%, coded 5237 (lumbosacral strain), citing limited motion, tenderness and Waddell signs 3/5.  There was no VA rating in evidence.  The Board noted the aforementioned MEB physical therapy examination supports a 40% rating based on 30 degrees flexion limitation of motion.  The Board majority concluded that evidence at the MEB NARSUM exam of non-physiologic pain was relevant to its deliberation in this case, and furthermore agreed that the ability to duck walk and bicycle for alternate physical fitness testing was inconsistent with such a dramatic degree of reduced flexion.  Though the STR spinal examinations prior to MEB physical therapy examination did not provide quantitative ROM findings they revealed a spine impairment due to painful motion and tenderness consistent with a 10% rating as adjudicated by the PEB.  There was no spinal spasm or guarding to cause an abnormal gait or spinal contour to support a 20% rating on this basis.  Although the CI had intervertebral disc syndrome with left sciatica, there were no incapacitating episodes (defined by the VASRD to require physician prescribed bedrest) documented within 12 months of separation which would provide for a higher rating under that formula.  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 lower back pain condition.

BOARD FINDINGS:  In the matter of the chronic low back pain condition and IAW VASRD §4.71a, the Board by a majority vote 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 20150620, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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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,