RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04734
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060206

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Health Care Specialist, medically separated for “chronic radiating low back pain” 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 - 20051212	VARD - 20060516	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Radiating Low Back Pain 	5243	10%	DDD Lumbosacral Spine 	5242	40%	20060310	
Recurrent Tinea Pedis	Not Unfitting	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began gradually in February 2005 after wearing a bullet proof vest and an AID bag.  During the 23 November 2005 MEB NARSUM examination, 3 months prior to separation, the CI complained of 7-8/10 low back pain that was sharp and throbbing.  He still experienced occasional pain that radiated down the left posterior thigh accompanied by tingling.  This occurred every two to three weeks and lasted about a minute.  Back pain was aggravated by prolonged standing and sitting.  Physical examination showed mild tenderness but no spasm or deformities.  Straight leg raise testing was negative bilaterally.  There were no motor or sensory deficits and strength was within normal limits.  Thoracolumbar range of motion (ROM) testing showed flexion of 40 degrees (normal 90) and combined ROM of 210 degrees (normal 240), after repetition, associated with painful motion.  

At the 10 March 2006 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported low back pain.  The examiner noted the CI ambulated without assistive device, was employed doing office work and was independent in activities of daily living.  Neurological examination showed sensory, motor and reflexes within normal limits.  Thoracolumbar ROM testing showed flexion of 30 degrees and combined ROM of 120 degrees, after repetition, and associated with painful motion.  There was guarding mostly with forward flexion, some straightening of the lumbar lordosis and tenderness, but no weakness or spasms.  Neurological examination was normal.  Neuroimaging in July 2006 showed levo convex scoliosis with kyphotic lumbar curvature.  Electrodiagnostic studies on 7 July 2006 demonstrated evidence of a mild to moderate L4-L5 radiculopathy on the left.  

The 31 July 2006 primary care clinic (PCC) examination showed lower back pain that radiated to the left lower extremity with occasional paresthesias (every 3 weeks or months).  ROM testing showed flexion of 60 degrees and combined ROM of 145 degrees, after repetition, associated with painful motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5243 (Intervertebral disc syndrome (IVDS)), citing para spinal muscle tenderness, motion limited by pain and no clinical signs of radiculopathy.  The VA rated the back condition 40%, analogously coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing forward flexion of 30 degrees with pain starting at 20 degrees, herniated nucleus and left radiculopathy.  

The panel considered the somewhat disparate examinations and 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 NARSUM and the PCC examinations.  The panel noted that the limitation of lumbar flexion of 30 degrees reported in the VA C&P examination suggested consideration of a 40% rating; however, the MEB and PCC ROM measurements were more consistent with the diagnostic and clinical pathology in evidence (consistent observations of normal gait, no muscle spasms or guarding, and combined ROM greater than 120 degrees).  Therefore the panel placed greater probative value on the MEB NARSUM and PCC examinations.  The panel considered whether a higher rating (§4.7) was achieved by using the alternate rating formula based on incapacitating episodes due to IVDS.  Although the CI had IVDS, there were no incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula (for IVDS).  

The panel also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  Pre-separation physical examinations revealed 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).”  There was no evidence in this case that motor weakness existed to any degree that could be described as functionally impairing.  The panel therefore concluded that an additional disability rating for radiculopathy was not justified on this basis.  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 back condition, coded 5243.  

Contended PEB Condition:  Recurrent Tinea Pedis.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the back condition, the panel recommends a disability rating of 20%, coded 5243 IAW VASRD §4.71a.  In the matter of the contended tinea pedis condition, the panel recommends no change from the PEB determination as not unfitting.  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 Radiating Low Back Pain 	5243	20%	

The following documentary evidence was considered:

 [AR NUMBER], XXXXXXXXXX

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Dear XXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not 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.

					      
Enclosure