RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01038
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080906

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Combat Engineer, medically separated for “multi-level degenerative disc disease of lumbar spine” with a disability rating of 10%.

CI CONTENTION:  The CI contends for his back and requests that his posttraumatic stress disorder (PTSD) be considered as well.  The complete submission is at Exhibit A.    

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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:  

SERVICE PEB - 20080724	VARD - 20081212	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Multilevel Degenerative Disc Disease Lumbar Spine	5243	10%	Degenerative Disc Disease, Lumbar Spine	5243	10%	20081126	
RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Lumbar Spine Degenerative Disc Disease.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in June 2006 when the vehicle he was driving while deployed was hit by an IED.  Imaging studies in August and September 2007 showed degenerative disc disease at L3 through S1 without evidence of spinal canal or neural foraminal narrowing.  There was no surgical indication.  Conservative treatment with pain medication, physical therapy, and chiropractic care did not result in sufficient improvement to meet the physical requirements of the CI’s military specialty, and he was referred for an MEB.  The MEB forwarded “chronic low back pain due to degenerative disk disease” for PEB adjudication.

At the VA Compensation and Pension (C&P) examination on 19 June 2008 (3 months before separation) the CI reported lumbar spine pain with right flank numbness aggravated by exercise, prolonged standing and changes in weather.  His pain was 6/10 in severity during flare ups, which lasted for hours.  Examination showed normal lower extremity neurologic findings.

The MEB NARSUM examination on 14 July 2008 (2 months prior to separation) noted complaints of constant low back pain at 5-6/10 in severity.  He could carry and fire a weapon but could not do any of the other physical requirements, including physical fitness activities.  He was taking narcotic medication daily for pain.  Physical examination showed normal neurologic findings and no evidence of nerve root irritation.

At a second C&P examination performed 3 months after separation, the CI reported that low back pain sometimes radiated to the right lower extremity.  The back pain occurred 3-4 times per week and was usually precipitated by bending or twisting.  Incapacitating episodes during the previous 12 months was denied.  He denied lower extremity weakness or difficulty driving a car.  He was able to walk without assistance and could run.  Examination reported “slight scoliosis of the lumbar spine to the right” and “mild tenderness and spasm of the paraspinal muscles on the right.”  Lower extremity neurologic findings were normal.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back pain condition 10% coded 5243 (intervertebral disc syndrome), citing limited ROM with consideration of functional loss.  The VA also rated the back pain condition 10% under the same code, and cited limitation of motion as the rationale.  The Board agreed that a 10% rating, but no higher, was warranted for limitation of flexion noted on most exams (greater than 60 degrees but not greater than 85 degrees) and for combined ROM on all exams (greater than 120 degrees but not greater than 235 degrees).  It was noted that muscle spasm associated with an abnormal spinal contour was reported on the PT examination 4 months prior to separation; and that the C&P examiner 3 months after separation noted mild spasm and a slightly altered spinal contour (scoliosis).  The Board concluded that this was not a sufficient basis for a 20% rating (i.e. for muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis).  The Board also considered whether a higher rating (§4.7) was achieved by using the alternate rating formula based on incapacitating episodes due to intervertebral disc syndrome.  However, there were no incapacitating episodes requiring bed rest prescribed by a physician to warrant consideration of a rating under that formula.  Finally, the Board considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  While the CI may have experienced radiating pain from the back condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  There was no evidence of an associated unfitting radiculopathy with functional impairments, such as weakness, with a direct impact on fitness for consideration of a separate peripheral nerve rating.  The Board therefore concluded that additional disability rating was not justified on this basis.  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 for the lumbar spine condition.

BOARD FINDINGS:  In the matter of the multi-level degenerative disc disease of lumbar spine 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.  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

MEMORANDUM FOR Commander, US Army Physical Disability Agency (AHRC-00), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXXXXX AR20160005841  (PD201401038)

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 
( ) OVA