RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02445
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060306

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E5, Health Care Specialist, medically separated for “low back pain,” with a disability rating of 20%.

CI CONTENTION:  “Review all conditions.”  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 - 20050923	VARD - 20131022	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain…	5299-5242	20%	Degenerative Disc Disease of the Lumbar Spine	5242	20%	20131010	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain Diagnosis.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in 2000 during a training exercise run.  Initial x-rays showed some L4-5 deterioration.  Treatment was medication and nine days of rest.  The CI then deployed for a six month tour and in September 2000 he was deactivated.  No serious back pain reoccurred until 2003 when the CI was in the process of training and being activated.  At this time, the CI reported pain in the lower back that resulted in him not passing the PT test.  On 16 December 2004 Magnetic Resonance Imaging studies (MRI) showed degenerative disc disease at L4-L5 and L5-S1 with central disc bulge at L5-S1.  There was no evidence of nerve root entrapment.  The CI was continued on conservative therapy.  In April 2005 electromyogram studies (EMG) were determined normal for the lower extremities.  In May 2005, the CI was evaluated by a neurosurgeon and determined not to be a surgical candidate.  

On 5 May 2005 range of motion (ROM) measurement, 10 months prior to separation, showed: flexion 65 degrees (normal 90); extension 20 degrees (normal 30); lateral flexion, right and left 20 degrees (normal 30); and right and left rotation 30 degrees (normal 30).  The 20 June 2005 MEB NARSUM examination, 9 months prior to separation, noted complaints of chronic lower back pain with some pain to the right lower extremity.  Right lower extremity pain was described as radiating to the front of the thigh, back of the right leg as far as the foot, with occasional tingling and sharp, stabbing pain to the right testicle.  No bowel or bladder dysfunction was reported.  Pain intensity was reported at 8-9/10.  Medications included Gabapentin (used to treat nerve pain) and Diclofenac (nonsteroidal anti-inflammatory pain med).  CI reported functional limitations to include inability to stand in formation for greater than 10 minutes.  Physical exam showed antalgic gait; heel and toe walk but there was a limping gait in the right lower extremity with each type of gait walking.  He was tender from L3 to S1 and there were right paralumbar muscle spasms.  The seated straight leg raise (test for underlying herniated disc) was positive on the right and negative on the left; and supine straight leg raising positive on the left at 75 degree with pain referred to the left buttock and positive on the right at 45 degrees with pain referred to lower back.  No neurosensory deficits were noted to the left lower extremity, but decrease light touch to all dermatomes were noted to the entire right lower extremity.  Axial loading was positive with pain on pelvic rotation.  At the 11 July 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 8 months prior to separation, physical exam showed reflexes 2+ to lower and upper extremities.  The 10 October 2013 VA Compensation and Pension (C&P) evaluation was outside the range to reflect the CI’s condition at discharge.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 20%, coded 5299-5242 (analogous to degenerative arthritis of the spine), citing EMG April 2005 normal for lower extremities, thoracolumbar range of motion limited by pain, tenderness to palpation, muscle spasm and antalgic gait.  The VA rating of the back condition on 22 October 2013, was outside the range to reflect the CI’s condition at discharge.  The panel agreed that a 20% rating, but no higher, was justified for muscle spasm or guarding severe enough to result in an abnormal gait reported on NARSUM examination dated 20 June 2005.  There was no associated radiculopathy for separate peripheral nerve rating.  EMG studies in April 2005, was normal for the lower extremities.  While the CI may have experienced radiating pain from the back condition this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  There was no objective evidence of a radiculopathy with functional impairment (such as weakness) that directly impacted fitness for duty.  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.  

BOARD FINDINGS:  In the matter of the back condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are 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 20150626, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170012919, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

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,