RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01222
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080226

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Automated Logistics Specialist, medically separated for “degenerative disk disease L5-S1,” with a disability rating of 20%.  

CI CONTENTION: Her condition continues to worsen and negatively impact her daily activities.  The applicant’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:  

PDA ADMIN CORR - 20080311	VARD - 200080512	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Disc Disease (DDD), L5-S1 with Intermittent Radicular Pain w/o Significant Neurologic Abnormality 	5242	20%	Degenerative Disc Disease	5243	0%	20080211	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

DDD, L5-S1 w/Intermittent Radicular Pain w/o Significant Neurologic Abnormality.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back pain (LBP) with lower extremity (LE) pain began in August 2005 during a field exercise, without any specific injury or trauma.  Magnetic resonance imaging (MRI) studies in October 2005 showed DDD at L5-S1 with mild spinal canal stenosis.  A second MRI study in July 2007 showed mild DDD at L5-S1.
Evaluation by orthopedics in July 2007 noted complaints of left LE radicular symptoms and decreased sensation, but the CI was noted to be a non-surgical candidate.  In the 12 months before separation, treatment notes indicated intermittent LE radiating pain, right greater than left, with occasional paresthesias (sensory disturbances, often numbness and tingling), which improved with chiropractic treatment and multiple epidural steroid injections (ESIs).  There were no periods of physician-prescribed bed rest or periods of quarters documented in the STR.

Despite treatment, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and she was referred for an MEB.  The MEB forwarded “degenerative disk disease L5-S1 with intermittent radiculopathy” for PEB adjudication.

At the MEB examination (recorded on DD Forms 2807 and 2808) dated August 2007, 7 months prior to separation, the CI reported LBP.  Physical examination showed tenderness, limited range of motion (ROM) with painful motion, negative straight leg raise test (SLR test to elicit radicular symptoms) and a normal gait.   

The MEB NARSUM examination on 9 October 2007 (4 months prior to separation) noted complaints of chronic back pain for several years stating some days were worse than others.  None of her treatment (chiropractic care, ESIs, profiles, and medication) alleviated her symptoms.  Physical examination showed tenderness of the paraspinal muscles, worse on the left and SLR was positive on the left.  Sensation, strength, reflexes, and gait were normal.  Thoracolumbar (TL) ROM performed by physical therapy (PT) noted forward flexion of 35 degrees (normal 90) and combined ROM of 150 degrees (normal 240) with painful motion noted.  The MEB examiner indicated there was an abnormal gait due to guarding noted by the therapist.

At the 11 February 2008 VA Compensation and Pension (C&P) examination performed less than 1 month before separation, the CI reported daily LBP described as aching and stiffness rated 6/10.  The CI reported chiropractic treatment every 2 weeks and ESI with good relief.  She was taking over-the-counter medication as needed for the LBP.  There had been no periods of incapacitation due to the back condition.  Physical examination showed a normal curvature of the spine with normal posture and gait.  Thoracolumbar ROM was normal without spasm, weakness or tenderness, and with minimal objective evidence of pain with extremes of forward flexion.  Bilateral LE examination was normal as noted at the MEB examination, but with negative SLR.

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating under the 5242 code (degenerative arthritis of the spine), citing average flexion ROM of 33 degrees, abnormal gait due to guarding and tenderness.  The VA assigned a 0% rating using the 5243 code (intervertebral disc syndrome) based on a VA C&P examination less than 1 month before separation, citing forward flexion greater than 85 degrees and a combined ROM of greater than 235 degrees.  

The Board reviewed the evidence to support a higher rating than that of the PEB.  There was no evidence in the record of 30 degrees flexion or less for the next higher rating of 40%.  Although the CI had intervertebral disc disease there were no incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula (for IVDS).  

The Board also considered if an additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  At treatment visits documented in the STR, the CI reported intermittent radiating pain to the bilateral LEs and occasional numbness.  Proximate to separation the LE symptoms were intermittent and there was no fixed motor or sensory deficits noted on examinations in the STR, the MEB examination, or at the C&P examination (the most proximate examination to the date of separation), which would impact military occupation-specific activities.  Radiating pain from the back condition is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  Therefore, the Board concluded that an 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 DDD.  

BOARD FINDINGS:  In the matter of the lumbar DDD 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 20140211, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

26 AUG 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, AR20160006671 (PD201401222)

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