RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00465
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060424

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Generator Mechanic) medically separated for a back condition.  The back condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was issued a permanent U3L3 profile and referred for a Medical Evaluation Board (MEB).  “Herniated nucleus pulposus in the lumber spine at the L5 level and in the thoracic spine at the T7-8 and T8-9 levels” and “neck pain, upper back pain, low back pain with spondylosis and sclerotic SI joints” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded eight other conditions (multiple joint arthralgias with positive bone scan showing large and small joint uptake consistent with degenerative joint disease, miscellaneous conditions and defects includes extremity complaints of the left shoulder, wrist, elbow, knee, ankle, foot, etc., spondylolysis L4 with grade 1 spondylolisthesis, elevated blood pressure SOB [shortness of breath] with exercise, hx [history] headaches w/left eye blurry vision asymptomatic, mental health evaluation and asthma).  The Informal PEB adjudicated “thoracolumbar pain with history of back trauma…” as unfitting, rated 10% with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be not unfitting.  The CI made no appeals and was medically separated.  

CI CONTENTION:  The applicant makes no specific contention in his application.  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 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 20060203	VA* - (~1 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Thoracolumbar Pain…	5237	10%	Osteoarthritis of the Thoracolumbar Spine	5242	20%	20060323	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 15 	
RATING:  10%	COMBINED RATING:  80%	
*Derived from VA Rating Decision (VARD) dated 20060428 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Thoracolumbar Condition.  The service treatment record (STR) and MEB narrative summary (NARSUM) documented a history of two separate slips on ice in January and February 2003 (3 years prior to separation), resulting in injury to the back.  The STR was silent for any evaluation until March 2005.  Radiographs were obtained for a “2-3 month history of low back pain with radiation to the left leg” and demonstrated degenerative disc disease of the L5-S1 level and a possible L4 pars defect (fracture).  At a physical therapy visit in April 2005 (12 months prior to separation), the examiner documented full thoracolumbar range-of-motion with “pain free” extension and flexion.  Tenderness was noted at the L4-L5 spinous process and paraspinal musculature.  Nerve tension testing was negative.  Radiographic evaluation of the thoracolumbar spine in May 2005 documented a normal lumbar spine with no evidence of fracture, dislocation, spondylolisthesis or spondylolysis with normal intervertebral disc spaces and vertebral height.  Radiographic imaging in June 2005 documented at L5-S1 disc bulge in contact with the left L5 nerve root.  At an orthopedic visit in September 2005 (7 months prior to separation), the examiner documented tenderness at the L4 spinous process and musculature with minimal spasm.  There was a normal gait with good range-of-motion (ROM) and mild guarding.  Sensation, strength, and reflexes were normal.  A back brace was ordered.  A bone scan in September 2005 documented a normal spine.  Flexion and extension radiographs documented a chronic L4 pars defect with Grade I L4-L5 anterolisthesis [< 25% slippage] without evidence of instability; and degenerative disc disease at L5-S1.  This was confirmed with more definitive imaging in October 2005.  Radiographic imaging of the thoracic spine in October 2005 documented a left sided disc bulge at T7-T8 and T8-T9.  

On the MEB DD Form 2807-1, Report of Medical History, dated 31 October 2005 (6 months prior to separation), the CI reported “tingling and numbness in the left leg usually when exercising.”  At orthopedic visit in November 2005 (5 months prior to separation), the CI reported 3-4/10 low back pain with aching and numbness over the anterior bilateral thighs, knees, and legs and paresthesias of the bilateral feet.  When severe, he could not get out of bed.  The examiner documented a normal gait with minimal spasm of the lower lumbar spine.  There was tenderness to palpation at the L4 midline and paraspinal musculature.  ROM was “good with mild guarding,” “more guarded” on flexion/extension, “fair with side bending and rotation” and “ratcheting on recovery from flexion.”  Sensation and strength were normal.  On the MEB DD Form 2808, Report of Medical Examination,dated 7 November 2005, the examiner documented a “normal” examination of the spine without tenderness to palpation and no indication of nerve irritation.  Physical therapy documented ROM in November 2005.  Thoracolumbar flexion was 75 degrees (normal 90), extension was 10 degrees (normal 30), bilateral flexion was 25 degrees each (normal 30), and bilateral rotation was 30 degrees each (normal 30).  The examiner documented that the reason for limitation was “mechanical block,” not pain.  There was no STR documentation of physician prescribed bed rest for incapacitating episodes and no documentation of thoracolumbar flexion of 60 degrees or less.  

The MEB NARSUM exam was performed on 6 December 2005 (4 months prior to separation).  The CI reported constant 7/10 low back pain with swelling and stiffness, worsened by walking, running, standing, bending over, and slouching while seated.  He reported numbness of the anterior left thigh that radiated down to the foot when the back pain was severe.  The CI also reported wearing a back brace and intermittent 5/10 upper back pain with no specific injury or onset.  The examiner documented normal gait and normal spinal curvature.  Tenderness was noted at the L4 level, with no muscle spasm in the upper back with minimal spasm in the mid and lower lumbar spine.  Range-of-motion was described as “good.”  Guarding was noted with flexion, extension, side bending and rotation.  

At the VA Compensation and Pension (C&P) exam performed on 23 March 2006 (1 month prior to separation), the CI reported a “moderate” response to a prescribed back brace.  The examiner documented a flexion of 70 degrees, extension of 20 degrees, bilateral lateral flexion of 20 degrees, and bilateral rotation of 15 degrees, all with painful motion and stiffness.  There was no abnormal spinal curvature and no evidence of radiculopathy.  The examiner further estimated a 5 degree functional loss due to flare ups and with repetition.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB adjudicated the thoracolumbar condition as unfitting rated 10%, coded 5237 (lumbosacral strain).  The VA rated 20%, coded 5242 (degenerative arthritis of the spine).  The Board considered the evidence for a higher rating.  There was pre-separation documentation of consistent thoracolumbar flexion of 60 degrees or less and no documentation of ankylosis in support of a higher than 10% rating.  There were no periods of physician prescribed bed rest noted in the record to support a higher rating under the alternate formula for intervertebral disc syndrome.  There was prior to separation evidence of thoracolumbar flexion of 65-75 degrees with painful motion in support of a 10% rating.  Although radiating pain and subjective numbness were reported prior to separation, there was no objective neurologic abnormality in evidence and no evidence of impairment of due to any radiculopathy.  Pain, whether or not it radiates, is considered under the general spine rating formula.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication of the thoracolumbar condition.  

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 thoracolumbar condition, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  

RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140111, 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 XXXXXXXXXXXXXXXXXXXXXXXXXXX, AR20160000216 (PD201400465)

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 and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA