RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03578
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20061213

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E8, Armor Senior Seargent, medically separated for “low back pain” with a disability rating of 10%.  

CI CONTENTION:  “Chronic pain:  Continues to impact all phases of my life.  It limits my activities and my ability to focus.  All symptoms from my release date remain.”  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 - 20061020	VARD – 20070521	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain 	5237	10%	Thoracolumbar Strain	5237	20%	20070117	
			Right L5-S1 Radiculopathy …	5237-8721	10%	20070117	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition began in October 2005 due to being a passenger when two planes collided on the tarmac.  The impact threw him forward and then recoiled him backwards.  He initially had some discomfort, but did not seek care.  Over the next several days, the CI’s pain escalated to 8-10/10 with lower extremity radiculopathy.  An MRI revealed Grade I anterolisthesis of the L5-S1 and foraminal narrowing.  Conservative treatment was not effective and surgery was offered, but declined.  

The 8 August 2006 MEB NARSUM examination, 4 months prior to separation, noted complaints of pain that was slight and intermittent.  Physical examination showed the CI could get to a standing position from sitting in a chair without any apparent significant discomfort.  Range of motion (ROM) performed with a goniometer revealed “full forward flexion, fingertips to the floor” (normal 90 degrees) with combined ROM at 220 degrees (normal 240).  There was painful motion with ROM testing.  There was no tenderness or spasm.  Muscle strength was normal (5/5) for all muscle groups of the lower extremities.  The CI was able to squat and heel and toe walk and had normal sensation of his bilateral lower extremities.  Neurological examination was normal.  Electrodiagnostic studies on 14 August 2006 were negative.  

At the 17 January 2007 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported constant mild low back pain averaging 8/10 and worse at 10/10.  Pain was sharp and achy and described as pressure type sensation.  The CI reported weakness of both lower extremities (right great than left), along with radicular symptoms to his great toe (right greater than left).  No bowel or bladder dysfunction was reported.  Pain was increased with sitting and standing more than 20 minutes.  Physical examination showed “gait was within normal limits, although slow with unequal weight bearing.”  He was able to walk on toes, heels, fully squat, and return to standing position.  ROM revealed forward flexion at 90 degrees with combined ROM at 150 degrees.  Pain was noted with extension between 0 and 1 degree, lateral bending with pain between 10 and 15 degrees, and lateral rotation with pain between 0 and 15 degrees.  Regarding DeLuca, following repetitive motion there was no further decrease in ROM of the lumbar spine for any reason.  Tenderness was noted over the lumbosacral spine, trapezius, and left sacroiliac (SI) joint.  Back and left SI joint musculature was remarkable for increased muscle tone and tension.  Deep tendon reflexes and motor strength were normal and symmetric.  Neurologic testing revealed decreased sensation in the right S1 and L5 dermatomes (compared to the left), and decreased bilateral proprioception.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back pain condition 10%, coded 5237 (lumbosacral strain), citing no tenderness or palpable spasm, and total ROM 219 degrees (220 degrees with application of VASRD spine rules note 4 - rounding).  The VA rated the thoracolumbar strain condition 20%, coded 5237 (lumbosacral strain), based on the C&P examination, citing ROMs “including when pain begins” of combined ROM of 110 degrees and granted for forward flexion of the thoracolumbar spine greater than 20 degrees but not greater than 60 degrees; or, the combined ROM of the thoracolumbar spine is not greater than 120 degrees.  The VA also rated a right L5-S1 radiculopathy condition, coded 5237-8721 (lumbosacral strain – neuralgia, external popliteal nerve [common peroneal]), based on the C&P examination, citing disruption of sensation with mild disability.  

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) and/or combined ROM (greater than 120 degrees but not greater than 235 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 documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes which would provide for a higher rating under that formula.  

The panel next considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI had bulging discs with moderate foraminal narrowing and radicular pain, and there were symptoms of radiating pain, numbness and tingling in his legs documented in the STR; however, radiating leg symptoms resolved after epidural steroid injections.  Pre-separation examinations indicated normal strength, reflexes, and gait; no sensory deficit; and normal electrodiagnostic testing.  Although sensory changes were noted at the post-separation VA examination, there were no objective findings of radiculopathy that would impact duty performance.  While the CI may have suffered additional pain from the nerve involvement, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  Therefore the critical decision is whether or not there was a significant motor weakness or sensory deficit which would impact military occupation-specific activities.  There was no evidence in this case that motor weakness or sensory deficit existed to any degree that could be described as functionally impairing.  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 there was insufficient cause to recommend a change in the PEB adjudication for the low back condition.  

BOARD FINDINGS:  In the matter of the low back condition 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.  

AR20180015388, 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.