RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00146
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070203

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Counter Intelligence Analyst medically separated for “chronic back pain without neurologic abnormality” with a disability rating of 10%.

CI CONTENTION:  “Review 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 - 20061101	VARD - 20080516	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain…without Neurologic Abnormality	5299-5242	10%	Chronic Lumbar Strain with DDD	5010-5237	40%	20080328	
RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Chronic Back Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic back pain began during advanced individual training (AIT) as the result of a twisting injury.  The CI was enlisted in the Navy until 1995.  In 1998 he joined the Army Reserve and thereafter transferred to active duty.  His back pain was long standing.  

Magnetic resonance imaging (MRI) in July 2006 showed no evidence of focal disc protrusion or extrusion and no significant central canal or neural foraminal narrowing at any level.  There was no surgical indication.

At the primary care clinic examination on 5 July 2006, 7 months prior to separation, the CI reported lower back pain on the right which radiated to the buttocks, anterior thigh and right knee.  There was no reported bowel or bladder dysfunction.  The CI reported occasional loss of strength in right leg when pain radiated, but he had not fallen down due to this.  He could not run but could walk at his own pace.  Physical examination showed painful limited range of motion (ROM) of the lumbosacral spine in multiple planes.  Spasm and tenderness were also noted by the examiner.  The CI had a normal neurologic examination, with normal strength, reflexes and sensation, but an abnormal right knee jerk reflex was recorded.

At the MEB examination (recorded on DD Forms 2807 and 2808) dated August 2006, 6 months prior to separation, the CI reported recurrent back pain.  Physical examination showed decreased flexion with chronic lumbar pain.

The MEB NARSUM examination on 21 September 2006, 4 months prior to separation, noted complaints of pain in the CI’s lower back.  He denied any radiation or numbness or tingling into his legs.  The pain was 4-6/10 (with 10 being the worst pain) in the morning and decreased to 2/10 at noon.  Symptoms were aggravated by prolonged sitting, standing, running, wearing gear, and lifting.

Physical examination demonstrated the CI had a normal gait.  He could heel and toe walk.  Range of motion (ROM) was recorded as forward flexion of 102 degrees (normal 90) and combined ROM of 230 degrees (normal 240).   The examiner noted there was no increase in the CI’s pain with any active ROM movements.

During the 28 March 2008 VA Compensation and Pension (C&P) evaluation 14 months after separation, the CI reported moderate to severe back pain, which radiated to the right thigh and buttock.  He used over the counter non-steroidal anti-inflammatory (NSAID) medication to treat the pain.  

Physical examination showed 35 degrees of forward flexion (after 3 repetitions) and 110 degrees of combined ROM.  There was tenderness along the paraspinal musculature and painful motion was documented.  Muscle spasms were evident, but the CI’s gait and spinal curvature were normal. The CI’s lower extremities were neurovascularly intact with normal strength, reflexes and sensation recorded.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic back pain condition 10%, analogously coded 5299-5242 (degenerative arthritis of the spine), citing combined thoracolumbar range of motion greater than 240 degrees, with localized tenderness.  The PEB also annotated the CI had no neurologic abnormality.

The VA rated the chronic back pain condition 40% analogously coded 5010-5237 (lumbosacral strain), based on the remote VA C&P examination 14 months after separation.

The ROM values reported by the VA examiner 14 months after separation are significantly worse than those reported by the NARSUM examiner 4 months before separation.  There was no record of recurrent injury or other development in explanation of the more marked impairment reflected by the VA measurements.  While ROM limitations may have progressed over time, there was no evidence in the record from which to conclude that the severity at separation approached that portrayed by the VA measurements.  Members agreed that the NARSUM examination was more consistent with the STR and more reflective of the anticipated severity based on the clinical pathology.  The panel therefore relied more heavily on the NARSUM examination measurements, and therefore the panel agreed that a 10% rating, but no higher, was justified for combined ROM (greater than 120 degrees but not greater than 235 degrees) reported on the NARSUM examination proximate to separation.  
Although there was muscle spasm, it was not 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 associated radiculopathy for separate peripheral nerve rating.  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.  The panel therefore concluded that an additional disability rating was not justified on this basis.  Finally, there was no evidence of intervertebral disc syndrome (IVDS) which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula (for IVDS).  

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 chronic back pain condition.   

BOARD FINDINGS:  In the matter of the chronic back pain condition and IAW VASRD §4.71a, the panel 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 20151119, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170014074, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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