RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  	CASE:  PD1201615
BRANCH OF SERVICE:  Army	BOARD DATE:  20130402
SEPARATION DATE:  20020930

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (31U/Signal Support Systems Specialist) medically separated for low back pain (LBP).  This soldier first complained of back pain in early 2000 and he was treated conservatively.  Imaging showed spondylosis of L5 and 1st degree spondylolisthesis of L5-S 1, and minimal arthritic changes at L3, L4, and L5 joints.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  His back conditions, characterized as “Chronic low back pain due to Grade I spondylolisthesis of L5 on S 1,” Degenerative disc disease at L3-4, L4-5, and L5-S 1,” and “Posterior osteophytic ridging with disc bulges present at L3-4 and L4-5,” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The PEB adjudicated “low back pain” as unfitting, rated 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The other conditions were not discussed.  The CI initially indicated non-concurrence but then concurred.  He made no appeals, and was medically separated with a 10% disability rating.

CI CONTENTION:  The application states simply, “Army rated at only 10% - My VA rating totaled 30% for my back/sciatic condition.  All of my VA pay was withheld as it was grouped as 1 injury.”  [sic]  The CI does not elaborate further or specify a request for Board consideration of any additional conditions.

SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The Service rating for the unfitting low back pain condition is addressed below.  The Grade I spondylolisthesis, DDD and posterior osteophytic ridging with disc bulges were findings which were part and parcel of the LBP condition and are accordingly addressed within the LBP section.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Army Board for Correction of Military Records.

RATING COMPARISON:  

Service IPEB – Dated 20020725	VA – 2 Wks. Pre/Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low back pain	5299-5295	10%	Low Back Pain with Spondylolisthesis of L5 on Sl, Degenerative Disc Disease at LJ-4, L4-5 And L5-Sl and Posterior Osteophyte Ridging with Disc Bulges at L3-4 and L4-5	5010 	10%	20020912	
Grade I Spondylolisthesis of L5 on S 1 (causing CLBP)	No remark by PEB					
Degenerative Disc Disease at L3-4, L4-5, and L5-S 1	No remark by PEB					
Posterior Osteophytic Ridging with Disc Bulges Present at L3-4 and L4-5.	No remark by PEB					
No Additional MEB/PEB Entries	Sciatic Compression, Right Trochanteric Notch	8520	20%	20020912	
	No Additional VA Entries	20020912	
Combined:  10%	Combined:  30%	

ANALYSIS SUMMARY:  

Low Back Pain Condition.  The narrative summary (NARSUM) notes that the CI had a history of LBP beginning in 2000, with radiation to the right leg at times.  Pain continued despite ongoing treatment and lumbar magnetic resonance imaging (MRI) showed Grade 1 spondylolisthesis, DDD, and degenerative arthritis, with disc bulging that did not cause any nerve impingement or spinal stenosis.  The CI was referred to a pain clinic but failed to improve with treatment.  At the MEB exam 20 February 2002, approximately 7 months prior to separation, the CI reported constant LBP and recurrent hip pain with a limp.  Running and doing marches aggravated the pain and caused radiation of the pain down the right lower extremity to his foot.  The MEB physical exam noted decreased flexion and extension of the lumbar spine, described as “the patient was unable to touch his toes.”  There was tenderness to palpation of the lumbar muscles.  There was normal strength and reflexes, and “a complaint of decreased sensation in the lateral aspect of the right leg” was noted.  At the VA Compensation and Pension (C&P) exam 12 September 2002, approximately 2 weeks prior to separation, the CI reported pain with sit-ups and other activity.  The VA exam noted lumbar flexion was 90 degrees (normal 90 degrees), extension 10 degrees (normal 30 degrees), right and left lateral flexion of 25 degrees (normal 30 degrees), with pain at all end range-of-motion (ROM).  Knee and ankle reflexes on the right were reported “2/3” and on the left “3/3.”  There was no muscle atrophy or deformity of either extremity.  The VA examiner also noted the CI’s history of right hip and leg pain and that palpation of the sciatic notch on the right reproduced the radiating pain to the back of the knee.  

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated LBP as 5299-5295 at 10% (lumbosacral strain with characteristic pain on motion).  The VA rated LBP as 5010 (traumatic arthritis) at 10%.  The VA also rated right sciatic compression as 8520 (incomplete paralysis of the sciatic nerve) at 20%.  The Board must apply the VASRD rating criteria in effect on the date of the CI’s separation and the Board did so.  There was no evidence in the record of incapacitating episodes as specified in the VASRD spine rating criteria in effect at the time of the CI’s separation.  The Board agreed that the CI’s LBP condition met the 10% rating under 5295.  The Board deliberated whether it met the next higher rating of 20%.  The Board agreed that the CI’s chronic LBP met the 20% rating under 5295 as evidenced by documented recurrent episodes of LBP with muscle spasm.  The Board next deliberated whether the CI’s right lower extremity pain indicated a separately ratable peripheral nerve disability.  Board precedent is that a functional impairment tied to fitness is required to support a recommendation for addition of a peripheral nerve rating at separation.  Exams 6 to 12 months prior to separation indicated the CI had normal strength, sensation, and reflexes.  An exam 5 months prior to separation indicated decreased sensation along the sciatic nerve distribution during an acute exacerbation with muscle spasms.  The VA exam noted the sciatic pain, along with mildly decreased knee and ankle reflexes on the right compared with the left and did not mention sensory deficits.  There is no evidence in the record of functional impairment due to either sensory decrease or muscle weakness of the right lower extremity.  The LBP condition was intermittently associated with radiation of pain to the right leg; the right leg pain was not a separate condition from the LBP condition.  Therefore, the Board cannot support a recommendation for additional rating based on peripheral nerve impairment.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the LBP condition coded as 5299-5295.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the LBP condition, the Board unanimously recommends a disability rating of 20%, coded 5299-5295 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Low Back Pain	5299-5295	20%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20120820, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

	Physical Disability Board of Review

SFMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(TAPD-ZB )

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for AR20130009106 (PD201201615)

1.  I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation to modify the individual’s disability rating to 20% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						

						         (Army Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA