RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01768
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040326

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

CI CONTENTION:  “Medical separation determination based on one condition without consideration of correlated leg and neuropathy issues derived from back injury sustained from roll-over convoy accident during international training mission.  Bilateral knee issues and left leg neuropathy continue to be treated and worsen due to degeneration of back spinal column and disk issues.”  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’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 panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’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 panel 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 panel 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 – 20040116	VARD - 20041129	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Subjective Back Pain	5242	10%	Degenerative Disc Disease, Lumbosacral Spine, with Disc Herniation, Left Neuroforaminal Stenosis and Arthritis	5010-5243	10%	20040817	
			Left Lower Extremity Radiculopathy	8699-8621	10%	20040817	
Patella Femoral Syndrome	Not Unfitting	Left Knee, Iliotibial Band Tendonitis and Patellofemoral Syndrome	5299-5262	10%	20040817	
		Right Knee, Iliotibial Band Tendonitis and Patellofemoral Syndrome	5299-5262	10%	20040817	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Subjective Back Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in August 2000 after training for the Army 10 mile marathon and then was exacerbated in March 2002 after a motor vehicle accident.  MRI showed disc bulges at L4-L5 and L5-S1 and an annular (disc fibrous exterior) tear at L5-S1 without definite nerve root compression.  X-rays showed L5-S1 facet osteoarthritis.  A repeat MRI showed a broad-based L5-S1 disc bulge, bilateral facet degenerative changes, and left greater than right neural foramina stenosis (narrowing of the nerve root opening).  

At the 29 October 2003 neurosurgery evaluation, 5 months prior to separation, the CI reported a 2 year history of low back pain.  She described it as an occasional 2-10/10 sharp, stabbing, needle-like pain.  “The patient has pain along her belt line which radiates to her hips, left greater than right, with pain down her bilateral lower extremities with numbness and tingling to her foot with noted weakness.”  Symptoms were exacerbated by sitting, standing, activity, pushing, pulling, and lifting and relieved by rest.  The physical examination documented a normal gait and station.  The back examination revealed a normal appearance and L5-S1 tenderness.  Active range of motion (ROM) values were flexion of 70 degrees (90 normal), extension of 30 degrees (30 normal), bilateral lateral flexion of 30 degrees (30 normal), bilateral rotation of 40 degrees (30 normal), and total combined ROM of 220 degrees (240 normal).  The Patrick test (assesses hip and sacroiliac [SI] joint pathology), femoral stretch test (assesses for upper lumbar nerve root compression), and straight leg raise test ([SLR] assesses for herniated disc causing sciatic nerve root [L5-S1] radiculopathy) were negative.  Strength, sensation, pulses, and deep tendon reflexes (DTRs) were normal and pathologic reflexes were absent.  The diagnoses listed lumbago with mechanical low back pain, L5-S1 severe degenerative disc disease, and lumbar spondylosis (spine degenerative disease) with a broad-based disc bulge.  The neurosurgeon opined: “The patient is a candidate for intradiskal electrothermal therapy at L5-S1 and a possible L5-S1 lumbar fusion.”  

The 21 December 2003 MEB NARSUM, 3 months before separation, reported a history of low back pain and SI joint dysfunction.  The back pain was constant and aching with intermittent sharp exacerbations to 9/10 pain.  Left lower extremity radiating pain, and patchy numbness and tingling, were very intermittent.  Symptoms were exacerbated by strenuous walking, running, and repetitive or heavy lifting greater than 15-20 pounds.  The CI denied changes in bowel or bladder function.  The back examination revealed SI joint and diffuse low lumbar spinal and paraspinal tenderness.  There were no gross steps-off, deformities, or increased paraspinal muscular tone.  “Lumbar forward and lateral flexion [was] normal and without pain exacerbation.  Lumbar extension exacerbates typical pain, as does left lateral rotation.”  The slump test (assesses for herniated disc causing sciatic nerve root [L5-S1] radiculopathy) and SLR test were negative.  Strength, sensation, and DTRs were normal.  Electrodiagnostic (EDX) testing was negative for left lower extremity radiculopathy (nerve root irritation or injury) or neuropathy (peripheral nerve irritation or injury).  

The 17 August 2004 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported left lower extremity numbness in her thigh, calf, and foot.  She also reported that her back bothered her at least twice a week and she had flare-ups that lasted 2-6 hours at a time.  The physical examination documented the CI was able to toe and heel walk.  The back examination revealed central and paraspinal (L4-L5, L5-S1) tenderness with no SI joint tenderness.  There were no deformities or abnormal spinal curvatures.  Pain-limited active ROM values were flexion of 90 degrees, extension of 25 degrees, bilateral lateral flexion of 30 degrees, bilateral rotation of 60 degrees, and total combined ROM of 235 degrees.  The left SLR test was positive with pain down the back of the leg.  Strength, DTRs, and sensation were normal except for decreased sensation in the left posterior thigh and calf and plantar aspect of foot.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5242 (degenerative arthritis of the spine), citing without neurological abnormality or limitation of motion.  The VA also rated the back condition 10% coded 5010-5243 (traumatic arthritis with intervertebral disc syndrome), based on the C&P examination 5 months after separation, citing tenderness and pain.  The VA additionally rated the left lower extremity radiculopathy at 10% under analogous code 8621 (external popliteal nerve neuritis), citing incomplete paralysis of foot movement which was mild.  The panel agreed that a 10% rating, but no higher, was justified for painful motion, tenderness, and limitation of flexion (greater than 60 degrees but not greater than 85 degrees) and/or combined ROM (greater than 120 degrees but not greater than 235 degrees) reported on the neurosurgery, MEB NARSUM, and VA examinations.  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.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the back condition.  

Contended PEB Conditions:  Patella Femoral Syndrome.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was profiled as a P2 (medically acceptable) and the condition was not implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the back condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended patella femoral syndrome conditions, the panel unanimously recommends no change from the PEB determination as not unfitting.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150630, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170008804, 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