RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01009
BRANCH OF SERVICE: Army 	SEPARATION DATE:  20090805

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Motor Transport Operator) medically separated for a back condition.  The back 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).  The “back pain due to degenerative disk disease,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded five other conditions (neck pain, pseudofolliculitis barbae, post-concussive syndrome, initial and maintenance insomnia, and adjustment disorder w/mixed emotional features) all meeting retention standards for PEB adjudication.  The Informal PEB adjudicated “degenerative arthritis of the spine” as unfitting, rated 20%, with 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 CI contends for his back along with PTSD.  The applicant’s 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 20090604	VA* - (~1 Week Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Arthritis of The Spine	5242	20%	Degenerative Disc Disease, Lumbar Spine	5242	20%	20090730	
Other MEB/PEB Conditions x 5 (Not In Scope)	Other x 10	
RATING:  20%	RATING: 40%	
*Derived from VA Rating Decision (VARD) dated 20090923 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Degenerative Arthritis of the Spine.  The first record in evidence for the low back pain (LBP) condition was documented in August 2008 at the medical clinic.  At the time the CI reported a 2-year history of chronic LBP that had increased in the last 6 months.  He had attended 2 years of physical therapy without much improvement.  Radiographs of the thoracolumbar spine on 26 August 2008 showed no evidence of spondylolisthesis, and the 10 September 2008 MRI demonstrated a normal spine and no significant degenerative disk disease.  However, radiologist documented mild degenerative disk disease at L4-L5 with mild right neural foraminal narrowing.  The narrative summary (NARSUM) dated 27 March 2009 documented the CI sustained an injury when he fell off a Bradley Fighting Vehicle during a firefight in Iraq, and was exposed to an improvised explosive device (IED) blast, in January 2007.  Since then, he has had dull aching, constant back pain that has caused spasmodic lock-ups.  In addition to the back locking up, he had associated muscle cramps in the neck and back which were radiating to his arms and legs.  The CI was placed on a restrictive profile and took over the counter anti-inflammatory medicine, and a muscle relaxant medication (Flexeril).  Upon his return to the States, he was having some back pain and was sent to physical therapy.  His condition was improving; however, in September 2008 he was hit by a delivery truck (he was a pedestrian) and suffered injuries to his head without LOC and right hand, and his back pain radiated down his legs.  The CI spent 2 days in the hospital and underwent 4 weeks of rehabilitation for his neck and back condition and for the glass pieces in his head and in his right hand.  His rehabilitation treatment consisted of aquatic therapy, lumbar traction, and other modalities.  The examiner also documented the CI fell from the staircase in an apartment complex 4 days prior to the motor vehicle accident.  His current medication included Motrin as needed, Tylenol over the counter, and Naproxen (non-steroidal anti-inflammatory) as needed.  Physical examination of the back documented the presence of muscle spasms, a normal gait, normal muscle strength in bilateral lower extremities, with normal vascularization and reflexes.  His spine was of normal contour, and no assistive devices were used for ambulation.  Thoracolumbar range-of-motion (ROM) recorded forward flexion on three trials at 40, 38, and 40 degrees (NL=90), and extension reduced at 15, 15, 12 degrees (30), and combined ROM of 120-131 degrees.  Despite the pain, the CI was able to heel and toe walk.  The examiner noted that the CI was evaluated by neurology in January 2009 and that exam recorded no sensory deficits and normal muscle tone.  The VA Compensation and Pension (C&P) exam was accomplished 6 days prior to separation and that exam of the back documented absence of deformity, tenderness and muscle spasm.  ROM measurements recorded forward flexion to 60 degrees (CI stopped forward motion due to pain between shoulder blades), and extension from 0-neg.30 degrees.  Multiple repetition of ROM did not induce fatigue, weakness, or lack of endurance.  The examiner reported that the CI has never had an incapacitating episode of the back.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition at 20% using the 5242 code under the general spine rules.  Absent the evidence of incapacitating episodes of a total duration of at least 4 weeks during the past 12 months the record supports no more than the 20% rating adjudicated by the PEB.  There were no additional codes to consider that would lead to a higher evaluation.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB determination for the low back pain 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 degenerative arthritis of the spine 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 20140219, 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 XXXXXXXXXXXXXXXXXXXXXX, AR20160002511 (PD201401009)

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