RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXX	CASE: PD-2017-06092
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20040828

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Light Wheeled Vehicle Mechanic, medically separated for “chronic 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 - 20040706	VARD - 20041004	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5243	10%	Postoperative Residuals Herniated Nucleus Pulposus (HNP) L5-S1	5241	10%	200#40609	
Spondylolysis without Spondylolisthesis	Not Unfitting	No VA Placement	
Congenital Idiopathic Scoliosis	Not Unfitting	No VA Placement	
Pes Planus, Mild Asymptomatic	Not Unfitting	No VA Placement	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

Chronic Low Back Pain. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s chronic low back pain began in July 2002 when lifting a self-recovery winch from a military vehicle. He was treated conservatively until November 2002, when, following a basketball game, he noted severe pain with radiculopathy to his right leg. In January 2003, X- rays showed spondylolysis (separation or fracture of the pars interarticularis) of L5 with no

evidence of spondylolisthesis (anterior slippage of one vertebra over another). An MRI on 20 February 2003 showed a large L5/S1 disc extrusion with left and right S1 nerve root involvement. The CI underwent a right L5-S1 lumbar microscopic discectomy on 22 April 2003 to treat the right herniated lumbar disc and right S1 radiculopathy. After an initial good recovery, he had pain into the right lateral foot and loss of reflex of the right knee.

Neurologic evaluation on 27 October 2003 revealed normal reflexes and a normal study of the peroneal, tibial, and femoral nerves. An electromyogram of the tibialis anterior, medial gastrocnemius, and vastus lateralis muscles was normal. On 19 November 2003, an MRI showed post-surgical changes by the right L5-S1 lamina with a mixed/patchy enhancement in the region of the bulge, which made delineation between a scar versus a recurrent bulge difficult. At a 27 January 2004 physical therapy visit, lumbar flexion was to 55 degrees (normal 60) (which converts to 85 degrees of thoracolumbar flexion), and combined ROM was 215 degrees (normal 240).

The 24 March 2004 MEB NARSUM examination, 5 months prior to separation, noted CI complaints of low back pain 75% to 100% of the time during waking hours. The pain disturbed his sleep and severely limited functional activities of daily living as well as military, social, and athletic activities, and he had to take anti-inflammatory and narcotic medications for comfort and performance during the day. He had difficulty running, jumping, marching, forward bending and lifting even moderate weights in excess of 15 lbs. Physical examination showed a slight antalgic gait on the right. He was able to sit without difficulty, but demonstrated some discomfort upon rising. Forward flexion was to “approximately 60 degrees” (normal 90) with fingertips 57 cm (22.44 inches) from the floor. Lateral side bends (flexion) to the right and hyperextension and rotation to the right and left were essentially within normal limits with discomfort during right side motions. Lasegue’s sign (to determine a herniated disc), and straight leg raising (to determine nerve root irritation) was positive on the right. He was able to heel-to- toe walk. The examiner noted a slight scoliosis with a slightly elevated left shoulder and a left rib hump. An Achilles tendon reflex was absent on the right and there was decreased sensation from the right knee to the mid portion of the fifth toe. Motor strength testing of the lower extremities was normal. Lumbar spine X-rays the same day demonstrated an exaggerated lumbar lordosis with increased acute angulation of the lumbosacral junction as well as L5 spondylolysis with no evidence of spondylolisthesis, acute bony changes or other abnormalities.

At the 9 June 2004 VA Compensation and Pension (C&P) examination, 3 months before separation, the CI reported back pain that continued to radiate down the right lateral leg, especially after prolonged sitting or standing. He reported normal erectile and bladder function, and that neurological symptoms had largely disappeared. Physical examination showed normal posture and gait and negative straight leg raising. Measured ROM, after repetition, showed flexion to 90 degrees (normal) and a combined ROM of 230 degrees. Lordosis was present with no paraspinal muscle spasms or tenderness to palpation. There was diminished sensation on the lateral aspect of the right thigh and calf, but motor strength and deep tendon reflexes were normal bilaterally. Lumbar spine X-rays in March 2005, 7 months after separation, were negative, while an MRI on 26 August 2005, 12 months after separation, demonstrated a large, central broad-based disc protrusion at the L5-S1 level.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the low back condition 10%, coded 5243 (intervertebral disc syndrome IVDS), citing the NARSUM examination results. The VA also rated the low back condition 10%, but coded 5241 (spinal fusion), based on the C&P examination, citing the VASRD rating criteria for a 10% rating. Panel members determined that the C&P examination held the highest probative value as it was a complete examination and was the closest to separation. While there was no limitation of thoracolumbar spine motion to support a compensable rating, but the examiner did note the presence of painful motion to support a 10% rating. There was no localized tenderness or any 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. Additionally, there was no history or evidence of vertebral body fracture with loss of 50% or more of the height; or evidence of additional functional loss that would impact functioning in the average civil occupation. There was no documentation of IVDS with incapacitating episodes which would provide for a higher rating under that formula. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the low back condition.

Contended PEB Conditions: Spondylolysis without Spondylolisthesis, Congential Idiopathic Scoliosis, and Pes Planus. The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting. The spondylolysis was indirectly referred to in both the profile and commander’s statement. However, neither the scoliosis nor the pes planus were addressed in either the profile or commander’s statement. None of the conditions failed retention standards. Spondylolysis without spondylolisthesis and congenital idiopathic scoliosis are related to and/or partially contributed to the unfitting low back pain, and therefore, a separate rating for either condition would be contrary to VASRD §4.14 (avoidance of pyramiding). There was no specific performance-based evidence from the record that any of the conditions independently or 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 any of the contended conditions, so no additional disability ratings are recommended.

BOARD FINDINGS: In the matter of the low back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the contended spondylolysis without spondylolisthesis, congenital idiopathic scoliosis, and pes planus, 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. Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.

PD-2017-06092

ARXXXXXXXXXXX, XXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXX

	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.

Sincerely,					      

Enclosure

PD-2017-06092