RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01569
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090210

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Cavalry Scout, medically separated for “lumbar intervertebral disk syndrome” with a disability rating of 20%.

CI CONTENTION:  The CI contends for his lower back condition.  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 - 20081107	VARD - 20090227	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar Intervertebral Disk Syndrome	5242	20%	Lumbar Strain	5237	20%	20081210	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Lumbar Intervertebral Disk Syndrome.  According to service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back condition began in August/October 2006 when he was involved in multiple improvised explosive device (IED) detonations while deployed to Iraq.  Diagnostic imaging performed in 2007 revealed an L4-L5 disc protrusion as well as degenerative changes in the lumbar spine.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “intervertebral degenerative disk disease (DDD) with disk protrusion at L4-L5” for PEB adjudication.
The MEB NARSUM examination on 2 September 2008, 5 months prior to separation, noted complaints of a constant, stabbing, sharp low back pain (LBP) with altered sensation extending into his feet.  His symptoms were aggravated by prolonged sitting, standing, walking, running, or lifting heavy objects.  Pain was relieved with rest and lying down.  The physical examination (PE) revealed tenderness and spasms over the lumbar spine.  Thoracolumbar range of motion (ROM) was decreased and painful.  At the 10 December 2008 VA Compensation and Pension (C&P) evaluation, performed 2 months before separation, the CI reported stiffness and numbness due to constant back pain that extended into both legs.  The pain was characterized as crushing, squeezing, burning, aching, sharp, sticking and cramping, with intensity of 7/10.  Physical activity and stress elicited pain while rest and medication relieved it.  The CI’s back condition did not result in any episodes of incapacitation.  His PE revealed a normal gait and posture and the CI did not require any assistive device for ambulation.  There was no evidence of radiating pain with thoracolumbar spinal motion.  Thoracolumbar ROM was decreased and painful.  There was lumbar spine tenderness present without spasms.  Neurologic testing was normal and the spine exhibited symmetry with a normal curve.  The joint function of the spine was not additionally limited by pain, fatigue, weakness, lack of endurance or incoordination after repetitive use.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating under the 5242 code (degenerative arthritis), citing limited forward flexion.  The VA also assigned a 20% rating using code 5237 (lumbosacral strain) based on the VA C&P examination 2 months prior to separation, citing forward flexion of the thoracolumbar 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 as reported on all examinations proximate to separation.  There was no evidence of intervertebral disc syndrome (IVDS) which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula (for IVDS).  The Board also 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 objective evidence of a radiculopathy with functional impairment (such as weakness) that directly impacted fitness for duty.  The Board therefore 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’s adjudication for the lower back condition.  

BOARD FINDINGS:  In the matter of the lower back 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 20140303, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

27 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, AR20160011066 (PD201401569)

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