RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01022
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20070510

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, “Network Switching Systems Operator-Maintainer” medically separated for “chronic back pain due to lumbar degenerative disc disease” with a disability rating of 10%.

CI CONTENTION:  Requested review of low back and conditions not identified by either the Medical Evaluation Board (MEB) or Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the MEB, but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.   

RATING COMPARISON:  

SERVICE PEB - 20070313	VARD - 20070802	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain Due to Lumbar Degenerative Disc Disease	5299-5242	10%	Degenerative Disk Disease and Degenerative Joint Disease, Lumbar Spine	5242	10%	20070626	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back pain (LBP) condition began in 2001 after heavy lifting and playing in a volleyball game.  At a family medicine appointment on 10 March 2006, the CI reported chronic LBP worsened by standing, walking, or bending, and relieved by lying down. He also reported lower extremity radicular pain with numbness in the limbs but no tingling.  Physical examination revealed tenderness over the right and left paraspinal regions in the middle back.  There was no erythema or warmth, gait and stance were normal, and straight leg raise (SLR) testing (to determine nerve root irritation) was negative.  There were no sensory abnormalities and motor strength and reflexes were normal.  Range of motion (ROM) measurements were not documented.  Radiographic imaging the same day showed disc protrusion at L4-5 directed to the right which produced foraminal stenosis (decreased size of the space where nerves pass through the vertebral column) as well as nerve root compression.  There was also a slight central protrusion seen at L5-S1 which produced minimal foraminal stenosis.  The CI had epidural steroid injections on 4 August 2006, 18 September 2006, and 23 October 2006 without much relief.  

At an orthopedic clinic visit on 3 January 2007, 4 months prior to separation, the CI complained of LBP radiating into the legs, which was worse on the left.  He had difficulty walking and standing and characterized the pain as constant.  Physical examination showed a negative SLR test.  Motor strength and reflexes were normal with no decreased sensation.  The orthopedist diagnosed lumbar spondylosis (degenerative changes).

At a physical therapy (PT) examination on 31 January 2007, 3 months prior to separation, thoracolumbar ROM measurements performed with an inclinometer (except for rotation which was assessed with a goniometer) were, in degrees: flexion to 30 (normal 90), extension to 5 (normal 30), left lateral flexion to 30 (normal), right lateral flexion to 25, left rotation to 30 (normal), and right rotation to 30, all with pain.  Combined ROM was 150 degrees (normal 240).  The physical therapist also reported localized tenderness, but no abnormal gait or spinal contour.  

The 22 February 2007 MEB NARSUM examination, 3 months prior to separation, noted CI complaints of LBP that was sharp in nature, with some throbbing and stabbing, and associated with numbness and tingling in both feet.  The pain was aggravated by prolonged standing, sitting, lifting and bending, and prevented him from fulfilling the requirements of his military specialty.  The CI participated in PT, pain management, and took a narcotic and nonsteroidal anti-inflammatory drug for pain relief.  Physical examination revealed him to be in no acute distress.  He had paraspinal tenderness but no muscle spasm.  Motor strength was 5/5 throughout; sensation was intact to light touch; his toes were down-gong; and he had no clonus.   Surgery was an option, but the CI reasonably declined after consulting with the surgeon.  At a 2 March 2007 family practice visit, 2 months before separation, there was lumbosacral spine tenderness and pain elicited by motion, but no muscle spasms or abnormal neurologic findings.
 
At the 26 June 2007 VA Compensation and Pension (C&P) evaluation, approximately 1 month after separation, the CI reported chronic LBP pain that sometimes radiated down his left leg and calf in a non-dermatomal distribution.  Flare-ups were triggered by weight-bearing activities but caused no additional weakness or restricted ROM.  He had functional limitations with standing, walking, lifting and prolonged sitting, but did not use a cane or brace, and had not been incapacitated during the previous 12 months.  Physical examination of lumbar spine showed a normal gait and spinal alignment, and no tenderness or muscle spasm.  Lumbar spine ROM measurements revealed 90 degrees flexion (normal) with pain at 90 degrees, and a combined ROM of 200 degrees (normal 240).  Bilateral SLR testing was negative and neurologic evaluation was unremarkable.  There was no additional weakness, fatigability, incoordination, or restricted limitation of motion or function impairment with repetition.  Motor strength, reflex and sensory findings were normal.  Lumbosacral spine X-rays demonstrated spondylolysis (a defect in the pars interarticularis) at L5 without listhesis (a vertebra sliding forward over the one below it).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP condition 10%, analogously coded 5299-5242 (degenerative arthritis of the spine), citing pain limited motion.  The VA also rated the LBP condition 10%, coded 5242 (degenerative arthritis of the spine), based on the C&P evaluation, citing painful motion.  Members noted that the PT ROM tests, 3 months before separation, showed forward flexion of 30 degrees but were measured primarily with an inclinometer.  The C&P evaluation showed flexion to 90 degrees, with painful motion, and was measured with a goniometer one month after separation, and thus, the panel placed higher probative value on this examination.  Members agreed that a 10% rating, but no higher, was justified for 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 at the C&P evaluation.  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 documentation of intervertebral disc syndrome with incapacitating episodes 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 panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the chronic back 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.  Therefore, the panel recommends 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 20170215, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180006632, 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