RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX.	CASE:  PD-2016-00177
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050509

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

CI CONTENTION:  The CI contends that the Army Medical Board considered his back issue, but did not consider his right ulnar neuropathy, limitation of right elbow flexion, radiculopathy, degenerative disc disease (DDD), or lumbago.  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 review of disability ratings assigned 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 or non-compensable.  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 determination 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(s) 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 – 20050412	VARD - 20151001	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Subjective Back Pain	5299-5242	10%	DDD and Lumbago	5237	20%	20150916	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

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 October 2000 after heavy lifting.  Radiographic studies showed DDD with L4-L5 disc protrusion impinging on the L4 nerve root.  Electrodiagnostic studies performed on 7 December 2004 were negative for radiculopathy.  Evaluation by neurosurgery recommended non-surgical treatment.  

At the time of the 9 December 2004 neurosurgery clinic appointment, 5 months prior to separation, the CI reported that he experienced back pain any time he lifted things or sat or stood for a long period of time.  He also reported that his back pain radiated to the mid-thigh and occasionally his right leg would go numb.  On examination the CI’s gait was normal; he had “no limitation of flexion or extension at the trunk” (the examiner did not address lateral flexion or rotation); there was no spasm or tenderness; straight leg raise testing (for radicular symptoms) was negative; and motor strength and reflexes were normal.  

At the time of the 29 March 2005 MEB clinic examination (recorded on SF 600), 1 month prior to separation, the CI reported low back pain with stooping and bending.  He also reported radicular pain to the back of his right leg.  On physical examination the thoracolumbar spine demonstrated full range of motion (ROM) with pain elicited by motion.  There was tenderness on palpation, but his gait was normal and there was no spasm or abnormal spinal contour.  Motor examination was normal.  

During the 31 March 2005 MEB examination (recorded on the MEB NARSUM, SF 600, and DD Forms 2807 and 2808), 1 month prior to separation, the CI reported back pain with standing and sitting, with pain that radiated to his right leg.  He also reported numbness in his right leg.  Physical examination showed ROM of 90 degrees forward flexion (normal 90) and combined thoracolumbar ROM of 235 degrees (normal 240) with pain.  There was tenderness to palpation, but his gait was normal and there was no spasm or abnormal spinal contour.  Motor strength, reflexes and sensation were normal and there were no radicular signs.  There was no VA examination in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5299-5242 (analogous to degenerative arthritis of the spine), citing “thoracolumbar combined ROM greater than 240 degrees.”  The VA rated the back condition 20%, coded 5237 (lumbosacral strain), based upon the VA evaluation over 10 years after separation, citing limited ROM.  

The panel adjudged that the NARSUM examination had the highest probative value for rating at separation.  The panel noted the PEB cited the combined ROM as “greater than 240 degrees,” which indicated that the PEB did not truncate measurements which exceeded the VASRD normal for rotation and lateral bending IAW note 2 of the VASRD spine rating (“The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion”).  

Rating under the general spine formula encompasses all disabilities for the thoracolumbar spine including chronic low back pain, degenerative disc disease (DDD), and lumbago.  The panel agreed that a 10% rating, but no higher, was justified for limitation of combined ROM greater than 120 degrees but not greater than 235 degrees, or tenderness or painful motion as reported on the MEB examination proximate to separation.  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.  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 that condition.  

The panel noted that the PEB considered radiculopathy in its adjudication and rendered a de facto “not unfitting” determination by explicitly stating “without neurologic or electrodiagnostic abnormality” in the disability description, and the CI contended this condition.  Radiculopathy is therefore in the panel’s scope of review and will be addressed.  

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.  

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 were no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160330, w/atchs
Exhibit B.  Service Treatment Record

	
AR20170014680, 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,					      
						      					
Enclosure