RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	              CASE:  PD-2014-00459
BRANCH OF SERVICE:  Army 	Seperation date:  20061116

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Light Wheeled Mechanic) medically separated for chronic low back pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The conditions “herniated disc; bulging disc L5-S1; lumbar radiculopathy and acquired spondylolisthesis” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded two other conditions (internal hemorrhoids and chronic cough) for PEB adjudication.  The Informal PEB combined the back conditions and adjudicated “chronic low back pain secondary to degenerative disc disease…,” as unfitting, rated 10%.  The remaining conditions were determined to be not unfitting.  The CI made no appeals and was medically separated.

CI CONTENTION:  His condition continues to worsen and negatively impact his daily activities.  Additionally, he was not evaluated for his leg, foot and erectile dysfunction conditions.  His complete submission is at Exhibit A. 

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’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/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.

RATING COMPARISON:  

IPEB – Dated 20061116	VA* - (~2 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain Secondary to DDD…	5299-5242	10%	Degenerative Arthritis and Anterolosthesis, T-Spine	5242	10%	**20070117	
Other x 0 (Not In Scope)	Other x 14	
RATING:  10%	RATING:  70%	
*Derived from VA Rating Decision (VARD) dated 20070312 (most proximate to date of separation (DOS)).  **C&P General Medical Exam dated 20070117 was not in evidence.  
ANALYSIS SUMMARY:  It was clear that there were various related diagnoses contributing to the disability in this case; and, members first agreed that there were no separate conditions which could be reasonably justified as separately unfitting; nor would separate ratings be achievable without violation of VASRD §4.14 (avoidance of pyramiding).  

Degenerative Disc Disease (DDD) with Anterolisthesis (Slippage).  The service treatment record (STR) documented an initial visit for back pain in June 2006 (5 months pre-separation) that began after a battalion run.  The CI reported difficulty dressing, bending, showering, walking, sitting, and going to the bathroom.  He denied bowel or bladder symptoms and denied tingling or loss of sensation to the lower extremities.  The examiner documented tenderness to palpation from T10-L1.  Another examiner documented decreased range-of-motion, tenderness to palpation of the L5 and S1 with paravertebral muscle spasm.  Strength was 4/5 with inability to perform straight leg raise but further details were not documented.  Radiographic imaging documented a bilateral pars defect (fracture) of L5, with anterior displacement of L5 on S1 (anterolisthesis) and disc herniation at L4-L5 abutting the L5 nerve root.  At an orthopedic consultation in July 2006 (4 months pre-separation), the examiner documented normal thoracolumbar flexion, extension, bilateral rotation, and bilateral lateral flexion with a normal gait.  There was tenderness to palpation of the L5 vertebra with no muscle spasms.  Nerve traction testing was negative.  Reflexes, strength, and sensation of the lower extremities were normal.  The examiner diagnosed a grade 1 spondylolisthesis, and prescribed medications and physical therapy.  At a physical therapy visit in July 2006, the CI reported constant 5-6/10 pain that increased with activity.  The examiner documented a mildly antalgic gait and decreased range-of-motion due to pain.  Flexion was 65 degrees (normal 90), extension 20 degrees (normal 30), bilateral flexion of 25 degrees each (normal 30), with right rotation to 30 degrees and left rotation to 20 degrees (normal rotation 30).  Nerve traction testing was positive and strength was 4/5 and “limited some due to pain.”  At a neurology consultation in August 2006 (3 months pre-separation), the CI reported pain radiating into the right leg more than the left, with paresthesias when squatting.  The examiner documented a normal gait and 5/5 strength bilaterally.  Electrophysiologic testing documented a lumbar radiculopathy involving the L5-S1 level on the left more than the right.  At an orthopedic visit in August 2006, the CI reported inability to lift more than 30 pounds due to the extreme back pain and inability to walk more than a mile without bilateral radicular leg pain.  The examiner documented normal gait, and tenderness to palpation at L5 with no muscle spasms.  Thoracolumbar flexion was to the “mid shins,” with all other planes of motion considered “normal.”  Strength, reflexes, and sensation were normal.  Nerve tension testing was negative.  Physical therapy ranges-of-motion obtained on 11 September 2006 (2 months pre-separation) were as follows: flexion to 35 degrees, extension to 25 degrees, right lateral flexion to 10 degrees, left lateral flexion to 15 degrees, right and left rotation were normal.  Painful motion was seen with all movements.  

On the MEB DD Form 2807-1, Report of Medical History, dated 16 September 2006 (2 months pre-separation); the CI reported paresthesias in his legs and feet.  On the MEB DD Form 2808, Report of Medical Examination, (dated 22 September 2006); the examiner documented tenderness to palpation from L4-S1, and decreased forward flexion (with reference to physical therapy measurements done previously).  The MEB Narrative Summary (NARSUM) exam was performed on 22 September 2006.  The CI reported constant pain that interfered with sleep and driving, and inability to stand or walk longer than 20 minutes before radiation of pain.  The examiner documented the ranges-of-motion obtained on 11 September 2006.  

At the VA Compensation and Pension (C&P) exam performed 17 January 2007 (2 months post-separation), the CI reported constant pain, relieved by rest and medication, and denied episodes of incapacitation.  The examiner documented a normal gait, tenderness of the spinous processes, normal curvature without muscle spasm and no evidence of nerve tension.  Painful motion was noted in all planes.  Thoracolumbar flexion was 90 degrees, extension 30 degrees, with normal lateral flexion and rotation bilaterally.  There were no further losses after repetition.  Radiographs documented generalized mild osteopenia.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB adjudicated the degenerative disc disease, bilateral pars defect, and Grade I anterolisthesis as a single unfitting condition rated 10% coded analogously as 5299-5242 (degenerative arthritis of the spine).  The VA rated the condition 10% coded 5242.  The Board considered the evidence for a higher rating.  There was no documentation of ankylosis to support a higher than 20% rating.  There was documentation of an abnormal gait, muscle spasm, and flexion to 35 degrees in support of a 20% rating.  There was no evidence of intervertebral disc syndrome, and after the initial injury in June 2006, there were no incapacitating episodes requiring bed rest prescribed by a physician.  All members agreed that there was no separately ratable neuropathy for disability, since no functional impairment linked to fitness was in evidence.  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 lumbar spondylolisthesis condition, coded 5242 (degenerative arthritis of the spine).  

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.  As discussed above, PEB reliance on AR 635-40 for rating the low back condition was operant in this case and the condition was adjudicated independently of that policy by this Board.  In the matter of the low back condition, the Board unanimously recommends a disability rating of 20%, coded 5242 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:  

CONDITION	VASRD CODE	RATING	
Chronic Low Back Pain Secondary to DDD… 	5242	20%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140110, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXX, AR20160002163 (PD201400459)

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, accept the Board’s recommendation to modify the individual’s disability rating to 20% without re-characterization 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:

CF: 
(  ) DoD PDBR
(  ) DVA