RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01190
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090327

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E6, Military Police, medically separated for “degenerative arthritis of the lumbar spine,” with a disability rating of 20%.

CI CONTENTION:  “Knee, back and PTSD due to evaluation criteria.  Knee and PTS received a zero rating.”  The CI’s 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 - 20090217	VARD - 20090616	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Arthritis of the Lumbar Spine	5242	20%	Degenerative Disc Disease, Lumbar Spine	5243	20%	20090427	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Degenerative Arthritis of the Lumbar Spine.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back pain began in March 2006 after slipping, falling and landing on his back.  Magnetic resonance imaging (MRI) completed on 22 April 2008 showed a mild disc bulge at L4-5, without evidence of overall canal stenosis (narrowing) or significant neural foraminal (nerve root opening) narrowing, and a minimal disc bulge at L5-S1.  A repeat MRI on 10 November 2008 showed a mild disc bulge at L4-5, and a minimal disc bulge at L5-S1, that were stable.  Evaluation by orthopedics on 4 December 2008 showed no tenderness to palpation, no muscle spasms, and the straight leg raise (SLR) test (assesses for herniated disc causing sciatic nerve root [L5-S1] radiculopathy) was negative. Sensation, motor, and strength testing were all normal.  Gait and stance were normal.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “lumbar spondylosis” and “lumbar disc bulging” for PEB adjudication.  

At the MEB examination (recorded on DD Forms 2807 and 2808) dated December 2008, 4 months prior to separation, the CI reported back pain with “every now & then” numbness and tingling in both legs.  Physical exam noted SLR testing produced symptoms in both legs.  The MEB NARSUM examination on 28 January 2009 (2 months prior to separation) noted complaints of worsening back pain described as constant and throbbing in the lower back, rated 7-8/10.  The CI was unable to wear his bulletproof vest or equipment belt in garrison.  The CI denied radicular (nerve root irritation or injury) symptoms.  On examination, there was no muscle spasm or guarding and gait, spinal contour, strength, and reflexes were all normal.  Thoracolumbar range of motion (ROM) measurements performed by physical therapy (PT) on 8 January 2009 are recorded in the chart below.  

At the VA Compensation and Pension (C&P) examination in April 2009, performed a month after separation, the CI reported low back pain with numbness and tingling on and off in the lower extremities.  The CI denied any periods of physician-prescribed bed rest during the previous 12 months.  Physical exam showed no tenderness, muscle spasm, or guarding and gait was normal.  The SLR testing was negative and sensory, motor, and reflexes were normal.  The ROM measurements are recorded in the chart below.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating under code 5242 (degenerative arthritis of the spine), citing limitation of forward flexion of 45 degrees.  The VA assigned a 20% rating under code 5243 (intervertebral disc syndrome) based on the VA C&P examination a month after separation, citing forward flexion of the lumbar spine greater than 30 degrees but not greater than 60 degrees.  The Board agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees) reported on the all examinations.  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 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 20140304, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

28 JUL 2016

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 XXXXXXXXXXXXXXXXXXXX, AR20160008286 (PD201401190)

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