RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXX	CASE: PD-2017-03762
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20060112

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E7, Culinary Specialist, medically separated for “chronic low back pain [LBP]” with a disability rating of 10%.

CI CONTENTION:  No specific contention was made.  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 - 20051105	VARD - 20060823	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP Secondary to Herniated Nucleus (L4-L5) Pulposus	5243	10%	Herniated Nucleus Pulposus, L3- L4 And L4-L5, (Claimed As Low Back Condition	5237	10%	20060615	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 30%	

ANALYSIS SUMMARY:

Chronic LBP. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s LBP began in October 2003 after performing sit-ups during annual training.  A CT scan performed on 19 February 2004 showed a mild diffuse bulging disc at the L3-L4 level and sacroiliac joint osteoarthritis. At L4-L5, there was diffuse bulging disc and a tiny central disc protrusion, along with some hypertrophic degenerative changes of the posterior elements, causing moderate narrowing of the canal and impingement of the thecal sac. An MRI performed on 21 August 2004 revealed a herniated nucleus pulposus of L3-4, which was paracentral and effacing the right L4 nerve root.       There was also a disk bulge in L4-5, which did not affect any

neural elements. He saw a neurosurgeon on 30 August 2004 and underwent 5 weeks of physical therapy along with epidural steroid injections without resolution of his back pain.

During the 6 November 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the examiner noted the lumbar spine had tenderness, reduced range of motion (ROM), negative straight leg raise (SLR) testing and deep tendon reflexes were + 2 with reduced extension. The MEB NARSUM examination 3 days later noted complaints of LBP with right radicular type leg symptoms. Physical examination showed a somewhat antalgic gait. His muscle strength was graded at 5/5 in the upper and lower extremities bilaterally. Deep tendon reflexes of C5-6-7 were graded at 2 out of 4. S1 deep tendon reflexes were graded at 3 out of 4. Sensation was somewhat diminished following the L4 dermatome on the right as compared to the left. He had a positive SLR test of the right lower extremity with a positive Lasegue's sign as well. Thoracolumbar ROM measurements, showed flexion 90 degrees (normal). He was unable to “hyperextend past 0 degrees” as this reproduced pain. Combined ROM could not be calculated. Left and right side bending caused some discomfort. He had significant paraspinal tenderness from approximately L1 to S1 bilaterally. He was able to heel and toe walk without difficulty.

At the 15 June 2006 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported pain was 7/10 most of the time. Physical examination showed his lower spine was tender to palpation of the paraspinal muscles with spasms noted and mild tenderness on palpation of spinous processes at L3-S. Bilateral SLR testing increased his LBP radiating to the buttock and posterior thigh, left at 40 degrees and right at 25 degrees. Romberg tests were negative; and he was able to rock up on heels and raise up on toes and take several steps forward without difficulty and able to tandem walk without loss of balance. Gait was slow and stable with widened base. The examiner noted the CI stood with 10 degrees of forward flexion and when he walked forward flexion increased to 25 degrees. His sensory was grossly intact and symmetric except for reduced in the right L4 and L5 dermatomal distributions when tested using nylon monofilament and vibratory stimulus. Thoracolumbar ROM measurements, showed flexion 65 degrees (normal 90) and combined ROM of 165 degrees (normal 240) with painful motion.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the LBP 10%, coded 5243 (intervertebral disc syndrome [IVDS]), citing chronic back pain, tenderness, flexion to 90 degrees, and no muscle spasm or radiculopathy. The VA also rated the LBP 10%, coded 5237 (lumbosacral strain), based on the C&P examination, citing pain and decreased ROM. 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 all examinations. However, it was noted that guarding associated with an abnormal gait was present on the NARSUM examination. The VA examination documented spasm with a widened and slow gait (abnormal; although not an antalgic gait) on the post-separation VA examination. The panel considered the NARSUM had the highest probative value for rating at separation and concluded that this was a sufficient basis for a 20% rating (i.e. for muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour). There was no documentation of IVDS with incapacitating episodes which would provide for a higher rating under that formula.  After due deliberation, considering all the evidence and mindful of  VASRD
§4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the low back condition, coded 5243.

BOARD FINDINGS: In the matter of the chronic low back condition, the panel recommends a disability rating of 20%, coded 5243 IAW VASRD §4.71a. There are no other conditions within the panel’s scope of review for consideration.

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Low Back Pain Secondary to Herniated Nucleus (L4-L5) Pulposus	5243	20%	

The following documentary evidence was considered: