RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX		CASE: PD-2017-04219 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20061207

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty, O1 , Signal Corps Officer, medically separated for “chronic low back pain” with a disability rating of 0%.

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 - 20050816	VARD - 20060726	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	0%	Degenerative Disc Disease [DDD] with Radiculopathy And Bertolotti Syndrome, Lumbar Spine	5243	10%	20051216	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

Chronic Low Back Pain (LBP). According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back condition began in March 2005 during a field training exercise. An X-ray on 13 July 2005 showed six lumbar vertebrae with hemisacralizaton of the left transverse process of L6 and narrowing of the L6-S1 disc space. He was seen in the chiropractic clinic for treatment without any significant relief of symptoms. Repeat lumbar spine X-rays on 24 August 2005 showed no change from the July findings, and thoracic spine X-rays on the same day revealed mild upper thoracic levocurvature (curvature to the left).  At the physical medicine

clinic on 7 September 2005, the CI was able to bring his fingertips to the mid tibia and had normal motions of hyperextension, twisting, and side bending. An MRI on 28 September 2005 showed DDD most prominent at L4-L5 with a left paracentral disc herniation at that level causing a left L4 nerve root compression.  There were also mild disc bulges at L3-4, L2-3, and L1-2.

At a neurosurgical visit on 15 November 2005, the CI had a normal gait and motor strength, but decreased sensation to the left leg in the L5 distribution. At a 4 March 2006 pain clinic appointment, he complained of LBP radiating to the legs, which was worse on the left. On examination, flexion was only to 20 degrees (normal 90), with pain. The examiner’s assessment was sciatica with the majority of symptoms in the left lower extremity (LLE), and a backache. Treatment consisted of Elavil (for nerve pain), and on 21 March 2006, he received a lumbar epidural steroid injection. An MRI dated 12 April 2006 demonstrated a left lateral recess disc extrusion at L4-5 compressing the L5 nerve root in the lateral recess. At an 18 May 2006 physical medicine visit, he could only bring his fingertips to the mid patellas and had a positive straight leg raise (SLR) test on the left indicating nerve irritation.

At the 25 May 2007 orthopedic MEB consultation, the CI reported LBP and radiating pain down the LLE into the top of the foot. On examination, he had some decreased range of motion (ROM) with lower lumbar flexion due to pain. There was no tenderness throughout the midline or paraspinous muscles, strength was normal in all major motor muscle groups in the lower extremities, and sensation was intact to light touch and pinprick in all lower extremity distributions. There were symmetric 1+ deep tendon reflexes in the patellar and Achilles tendons bilaterally, and heel and toe walking were within normal limits. There was reproduction of the radiating back pain to the left buttock and left thigh with a SLR that did not radiate down into the foot.  There was also some reproduction of the left LBP with a contralateral SLR.

At the 10 January 2007 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported LBP every day, but not all day. The examiner found normal spinal curvatures with no tenderness or spasms. Thoracolumbar flexion was to 55 degrees (normal 90) with a combined ROM of 205 degrees (normal 240), and no pain or diminution of motion with repetition. Straight leg raising bilaterally was positive, but the lower extremities had normal sensation and motor strength throughout. Deep tendon reflexes at the knees and ankles were 2+, and X-rays revealed no significant pathology. The examiner’s final diagnosis was sacralization of L5 and a herniated lumbar disc at L4-5 with sciatica.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the back condition 0%, coded 5237 (lumbosacral strain), citing low back strain without complications. The VA rated the back condition 10%, coded 5243 (Intervertebral disc syndrome (IVDS), based on the C&P examination, citing pain. Panel members agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees) as reported on the MEB, NARSUM, and VA examinations. There was no documentation of IVDS with incapacitating episodes which would provide for a higher rating under that formula.

The panel considered whether an separate rating could be recommended under a peripheral nerve code. Although the pain component of the neuropathy is appropriately subsumed in the spine rating IAW VASRD §4.71, which states that “rating is performed with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease,” there was no sensory component with any significant functional implications; no motor weakness was in evidence; and electrodiagnostic studies of the LLE were normal. Therefore, the panel determined a radiculopathy was not separately unfitting and cannot not be recommended for an additional disability rating. 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 5237.

BOARD FINDINGS: In the matter of the low back condition, the panel recommends a disability rating of 20%, coded 5237 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	5237	20%	

The following documentary evidence was considered:

PD-2017-04219 

AR20190012131, XXXXXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXXX

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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 also been provided to the Department of Veterans Affairs. 

PD-2017-04219