RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX	CASE: PD-2014-00893
BRANCH OF SERVICE:  Army	BOARD DATE:  20150227
SEPARATION DATE: 20090611

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Supply Sergeant) medically separated for chronic low back pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “lumbago” condition was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “degenerative disc syndrome” as unfitting, rated 10%, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “I was told I had degenerative disk syndrome and lumbar spine strain.  I was just told it could not be treated or fixed.  I am on pain medication for the rest of my life.”

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 20030903	VA* - ~2 Months Post-Separation	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Disc Syndrome	5242	10%	Lumbar Spine Strain (Claimed as Lumbago)	5237	0%	20090821	
Other x 0 (Not In Scope)	Other x 6	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20090921 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Degenerative Disc Syndrome.  The narrative summary and record noted onset of lower back pain with onset in December 2005 following a fall.  The CI had constant pain with increase following activities with no radicular symptoms.  Conservative therapy of oral medications, epidural steroid injection, and physical therapy were not effective and the CI never had back surgery.  Lumbar spine magnetic resonance imaging in January 2009 documented a degenerative subchondral cyst at the left sacral joint and mild facet degenerative disc disease.  CT from 2006 documented osteophyte (arthritic changes) at the sacroiliac joint, while plain lumbar spine X-rays in 2009 were unremarkable.  The MEB physical exam, performed 5 months prior to separation, noted a normal gait with negative radicular testing (straight leg raise [SLR]), and normal reflexes, sensation and strength in the lower extremities.  The lower spine was tender with goniometric range-of-motion (ROM) evaluation documenting pain-limited forward flexion to 80 degrees (normal 90 degrees) and combined ROM of 215 degrees (normal 240 degrees).

At the VA Compensation and Pension exam performed 2 months after separation, the CI reported intermittent back pain and stiffness getting progressively worse and that he was under no treatment and had no flare-ups.  Exam documented a normal gait with no deficits noted in motor, reflex, or sensory testing.  SLR was negative.  ROM was normal (flexion 90 degrees/combined 240 degrees) with no pain on motion or change following repetitions.  There was no lower back tenderness or muscle spasm.  Spine X-rays were normal.  VA treatment records from 13 November 2009, 5 months after separation, were reported as documenting full ROM with painful motion and muscle spasm, and the VARD dated 15 January 2010 increased the VA rating to 10% effective the date of that treatment note.

The Board directed its attention to its rating recommendation based on the above evidence.  The MEB exam documented tenderness and pain-limited ROM within the 10% criteria IAW VASRD §4.71a.  Pain (whether or not it radiates), stiffness, or aching is rated under the general formula for the spine and is considered in the 5243 rating.  There were no incapacitating episodes for any higher rating under the formula for rating intervertebral disc syndrome based on incapacitating episodes.  There was insufficient evidence that the ROMs were limited to flexion of 60 degrees or combined ROM of 120 degrees, or that there was muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour to warrant any higher rating.  There were no radicular symptoms or objective neurologic deficits and therefore no unfitting peripheral nerve disability was in evidence.  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 10% for the lower back (degenerative disc syndrome) condition was appropriately recommended in this case.

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 low back (degenerative disc syndrome) condition and IAW VASRD §4.71a, 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 20140220, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXX
President
DoD 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, AR20150013330 (PD201400893)

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:

Encl						     XXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA