RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02277
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060520

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Motor Transport Operator, medically separated for “chronic radiation low back pain (LBP)” with a disability rating of 10%.  

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 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 Medical Evaluation Board (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 - 20060327	VARD - 20060825	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Radiation LBP	5299-5237	10%	Mechanical Low Back Strain with Multi-Level DDD and Small Disc Protrusion at L5-S1	5242	10%	20060822	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Radiation LBP.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s radiating LBP began in April 2004 following a 12-hour drive and then standing guard that night.  She reported an abrupt loss of strength in both of her legs and she fell to the ground.  No trauma was reported.  Treatment was conservative and the CI was returned to work.  A CT of the lumbar spine in October 2004 showed a small broad-base posterior disc bulge at the L5-S1 level, without spinal canal or neuroforaminal narrowing.  An epidural steroid injection was performed on 18 November 2004 and the CI experienced new onset of radiating pain down the right leg and numbness, which had not existed prior and was persistent.  Treatment remained conservative, but was unsuccessful in resolving the symptoms.  

Thoracolumbar range of motion (ROM) measurement performed for the MEB on 1 December 2004, 6 months prior to separation, showed flexion of 90 degrees (normal) and combined ROM of 230 degrees (normal 240).  There was complaint of pain limiting motion.  On 1 February 2005, lumbar spine X-rays showed minimal lumbar spine disc space narrowing with a slight leftward curve of the lumbar spine.   Two days later, the MEB NARSUM examination conducted 4 months prior to separation, noted complaints of constant back pain.  When the pain intensified it radiated bilaterally down both legs to the knees, with intermittent numbness in the toes, right greater than left.  Physical examination showed a normal gait and the CI moved during the examination without difficulty.  ROM showed forward flexion to about 70 degrees (normal 90), but the combined ROM measurements were not complete.  Bilateral tenderness of the paraspinous muscles was noted.  Strength and reflexes were normal.  Straight leg raise testing to elicit radicular symptoms caused pain on both sides of the lower back.  An MRI on 15 February 2006 showed degenerative disc disease (DDD) at L4-5 and L5-S1, without nerve root impingement.  

At the 22 August 2006 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported pain over the mid to upper lumbar spine along the midline with occasional radiating pain and numbness to the right lower extremity.  She denied any incapacitating episodes with bedrest prescribed by a physician.  Physical examination showed a normal gait.  There was no tenderness or muscle spasm.  Forward flexion after repetition was 80 degrees with combined ROM of 225 degrees; all planes were noted to have mild pain.  Sensation was decreased over the anterolateral right lower leg.  No muscle atrophy was noted and deep tendon reflexes were intact.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, analogously coded 5299-5237 (lumbosacral strain) citing tenderness.  The VA also rated the low back condition 10%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees.  

The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) as reported on the 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.  There was no evidence of intervertebral disc syndrome which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula for that condition.  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).”  The panel therefore concluded that an additional disability rating was not justified on this basis.  After due deliberation, considering all 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 radiation low back condition.  

BOARD FINDINGS:  In the matter of the chronic radiation low back pain and IAW VASRD §4.71, 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 20170222, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190007806, 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.

A copy of this decision has been provided to the counsel you listed on your application, Disabled American Veterans (DAV), 3800 Village Drive, PO Box 85816, Lincoln, NE 68501-5816.

Sincerely,					      
Enclosure