RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX		CASE:  PD-2014-01263
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20081109 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Ammunition Supply Specialist) medically separated for neck and back conditions.  The neck and back conditions could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).   He was issued a permanent U3 L3 profile and referred for a Medical Evaluation Board (MEB).  “Chronic lower back pain due to degenerative disc disease [DDD]” and “chronic neck pain with degenerative disc disease” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted.  The Informal PEB adjudicated lumbar DDD and cervical DDD as separate unfitting conditions, rated 10% each, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI submitted additional information for PEB reconsideration.  The PEB affirmed the IPEB findings.  The case was reviewed by United States Army Physical Disability Agency which affirmed the PEB findings and ratings.  The CI was medically separated.  

CI CONTENTION:  The applicant makes no specific contention in his application.  His 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 20080509	VA* - (2 Mo. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar DDD	5243	10%	Lumbar DDD	5242	10%	20090108	
Cervical DDD	5243	10%	Cervical DDD	5242	10%	20090108	
Other MEB/PEB Conditions x 0  	Other x 7 	
COMBINED RATING:  20%	COMBINED RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20090512 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:    

Lumbar Spine Condition.  The service treatment record (STR) corroborates the history in the narrative summary (NARSUM) of a long standing history of back pain precipitated by lifting, which was exacerbated by an Iraq deployment and required medical evacuation in July 2006.  Magnetic resonance imaging (MRI, serial studies) demonstrated DDD with protrusions at L4/5 and L5/S1 (without neural impingement, later confirmed by discogram), and there were multiple STR entries confirming a protracted trial of conservative measures (including epidural steroid injections) of no avail.  There were multiple entries documenting bilateral lower extremity radiation, sensory complaints, and subjective weakness; although, there were numerous normal neurological examinations (5/5 strength all groups), with none to the contrary.  A neurosurgical consultant in June 2008 (5 months pre-separation) detailed normal neurological testing.  A surgical option was reasonably declined.  Numerous STR entries recorded grossly normal range-of-motion (ROM), although a few noted pain limited flexion/extension, and one documented a disparity between occultly observed ROM and that displayed on exam.  There were multiple entries which documented a normal gait and normal spinal contour with none to the contrary; and, there was no STR documentation of incapacitating episodes.

The NARSUM was conducted 7 March 2008 (8 months pre-separation) and documented “daily” back pain rated 2-6/10, with bilateral radiation and “numbness and tingling,” which was aggravated by lifting, bending, and prolonged standing.  The NARSUM physical examination recorded a normal gait and spinal contour, tenderness, the absence of spasm, and normal neurological findings.  The NARSUM addended MEB physical therapy ROM measurements noted flexion to 90 degrees (normal) and combined ROM of 220 degrees (normal 240), annotating painful motion.

A VA Compensation and Pension (C&P) examination was conducted 8 January 2009 (2 months post-separation) and documented constant pain rated 6/10, with subjective bilateral leg weakness, making it “difficult to sit, stand, [bend], or walk.”  The VA physical examination recorded a normal gait and spinal contour, tenderness, the absence of spasm, and normal neurological findings.  The VA measured ROM was normal in all planes.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating under 5243 (intervertebral disc syndrome) was consistent with VASRD §4.71a criteria for the Service ROM evidence and other ratable findings.  The VA’s 10% rating under 5242 (degenerative arthritis of the spine) invoked painful motion.  There was no ROM evidence supporting a rating higher than 10%, no evidence for abnormal gait or contour to support a 20% rating, and no documentation of incapacitating episodes which would provide for a higher rating under that formula.  The Board considered whether an additional rating could be recommended under a peripheral nerve code for the radicular symptoms; but, members agreed that neither the functional link to fitness requisite for rating, nor the presence of a VASRD ratable deficit, were supported by the evidence.  It is further noted that rating for the associated neuropathy was considered by the VA and denied on the basis that there were “[no] findings associated with the reported symptoms.”  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 of the lumbar spine condition.

Cervical Spine Condition.  The STR and NARSUM indicate a gradual onset of neck pain in 2005 associated with operational and MOS requirements.  An MRI (with serial studies) diagnosed disc disease (“small” protrusion at C5/6 without neural impingement), and the clinical course was similar to that described for the lumbar spine condition.  There were radicular complaints, but no objective findings on multiple neurological examinations.  There was STR confirmation of normal contour and numerous STR entries indicating grossly normal ROM.  The above referenced neurosurgical consultation also addressed the cervical disease, with equivalent normal findings and disposition.  There were no STR entries contrary to any of these ratable features, or documentation of incapacitating episodes.

The NARSUM documented persistent neck pain rated 4-7/10 with subjective hand and arm weakness and “aggravated by certain positions of the neck.”  The physical examination recorded normal spinal contour, tenderness, the absence of spasm, and normal neurologic findings.  The MEB physical therapy ROM measurements were flexion to 35 degrees (normal 45) and combined ROM of 290 degrees (normal 340), annotating painful motion.

The post-separation VA C&P examination documented constant pain rated 7/10 with no elaborated radicular symptoms other than numbness and making it “difficult to sit and read or hold my head at certain positions.”  The VA physical examination recorded normal spinal contour, tenderness, the absence of spasm, and normal neurologic findings.  The VA measured ROM was normal in all planes.

The Board directed attention to its rating recommendation based on the above evidence.  The 
PEB and VA coding and rating were equivalent to those for the lumbar spine, and compliant with §4.71a for the evidence on which they were based.  Based on the same criteria and rationales as those for the lumbar spine decision, the evidence does not support a rating higher than 10%; and, there was insufficient justification for additional rating of neuropathy (also denied by the VA as for the lumbar condition).  After due deliberation, considering all evidence and with deference to reasonable doubt, the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication of the cervical spine 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 established that no such prerogatives outside the VASRD were exercised in this case.  In the matter of the lumbar spine condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the cervical 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.    

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 20140311, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXXXXX AR20160003964 (PD201401263)

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