RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01796
BRANCH OF SERVICE:  Army	BOARD DATE:  20140624
SEPARATION DATE:  20050923

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (15Y10/AH-64D Armament/Electrical/Avionic Systems Repairer) medically separated for a back condition.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The back condition, characterized as “chronic low back pain with right leg radiculopathy,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated chronic low back pain condition as unfitting, rated 10%, with application of the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI elaborated no specific contention in his application.

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 rating for the unfitting back condition is addressed below.  Any other condition or contention not requested in this application, remain eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Service IPEB – Dated 20050614	VA - (Pending)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	VARD Pending	--	--	--	
Other x 0 (Not in Scope)	Other x -	--	
Combined:  10%	Combined:  ##%	

ANALYSIS SUMMARY:  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on ratable severity at the time of separation.

Chronic Low Back Pain.  The CI reported a history of back pain since August 2004 after riding in the back of a Humvee in full battle gear.  The next day he felt sharp pain in his right leg while trying to support an ammunition magazine.  He continued his training mission.  He was referred to chiropractor, orthopedics, physical therapy and pain management.  He failed conservative treatments, including epidural injection and he was not a surgical candidate at that time.  A magnetic resonance imaging study on 12 October 2004 found mild to moderate right paracentral spinal stenosis due to a right paracentral disk protrusion at the L4-5 level.

An orthopedic consultation on 3 December 2004, 9 months prior to separation, found the CI in moderate distress from back and right leg motion.  He walked with an obvious gait disturbance and had trouble with flexion and extension of his back during positioning in the room.  Straight leg raising test for radiculopathy was positive on the right, motor strength was 4/5 on the right, 5/5 on the left, pain to palpation over the L4-S1 region right more than left.  There was painful forward flexion to approximately 70 degrees, unable to extend past neutral.  At the MEB narrative summary (NARSUM) examination dated 11 May 2005, 4 months prior to separation, the CI complained of lumbar and right leg pain 3-4/10 worse with walking, jumping, lifting, driving and standing for approximately 15 minutes.  Physical examination revealed lumbar spine spasm and straightening of the normal lumbar lordotic curve.  Straight leg test for radiculopathy were negative bilaterally, neurologically intact and equal bilaterally, no clonus, no muscle wasting and good strength.  Range-of-motion (ROM) was referenced to physical therapy done eight days prior on 3 May 2005 and summarized below.  There was no VA Compensation and Pension examination in the record.

The ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Thoracolumbar ROM
(Degrees)	Ortho 5 mos. Pre-Sep
(20050504)	NARSUM 4 mos. Pre-Sep
(20050511)	PT 4 mos. Pre-Sep
(20050503)	
Flexion (90 Normal)	70	--	80	
Extension (30)	0	--	15	
R Lat Flexion (30)	--	--	20	
L Lat Flexion (30)	--	--	35	
R Rotation (30)	--	--	35	
L Rotation (30)	--	--	35	
Combined (240)	--	--	220	
Comment	Gait disturbance.
Painful ROM.
Positive R SLR.
Weaker R motor.	Lumbar spasm.
Straightening of lumbar lordotic curve.
Normal motor strength.	MEB ROM 	
§4.71a Rating	10%	20%	10%	

The Board directs attention to its rating recommendation based on the above evidence.  The Board considered VASRD diagnostic code 5237 (lumbosacral or cervical strain) used by the PEB for a 10% rating.  The NARSUM exam and the subsequent PT ROM, were the most proximate to separation and were considered most probative for a rating recommendation at the time of separation.  The Board found evidence of lumbar spasm and straightening of the lumbar lordotic curve, for a rating of 20% based on the NARSUM examination.  There were no ratable ROM limitations, no episodes of incapacitation or neurological compromise, for a higher rating under alternate or additional VASRD codes.  The Board found the radiating radicular pain component was subsumed under the §4.71a code 5237 rating which states 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.”  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 chronic low back pain (LBP) condition.

BOARD FINDINGS:  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 chronic LBP condition, the Board unanimously recommends a disability rating of 20%, coded 5237 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	
Chronic Low Back Pain Condition	5237	20%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131021, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

				
XXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXXX, AR20150001216 (PD201301796)

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						     XXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA