RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-01741
BRANCH OF SERVICE:  Army	BOARD DATE:  20150319
Separation Date:  20070606

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Information Systems Operator-Analyst) medically separated for lumbar degenerative disc disease (DDD).  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The condition characterized as “chronic low back pain (LBP) with DDD at L4/L5,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “lumbar degenerative disc disease without neurologic abnormality” as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions.  My back has gotten worse.  My hips and legs hurt much more than before.  My doctors have assigned me to the Pain Management Clinic to try to help.  I have used an external TENS unit, but I was prescribed an internal TENS last summer and I have been waiting for the VAMC to schedule the surgery, but no one has contacted me yet.”

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 20070430	VA* - (~6 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar DDD without Neurologic Abnormality	5299-5242	10%	Lumbar Spine DDD	5242	10%	20071210	
Other x 0	Other x 1	
RATING:  10%%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20080225 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Lumbar DDD Condition.  The CI had a slow insidious LBP develop while he was in Theater in 2005.  He sought medical treatment when he could not stand for more than 20 minutes without pain.  The Medical provider documented that the CI reported midline LBP and pain radiation worse with movement.  There were physical exam findings of pain with all range-of-motion (ROM).  The examiner prescribed a non-steroidal anti-inflammatory drug and a muscle relaxant.  The physical therapist noted chronic, intermittent LBP that radiated to the buttocks and back stiffness.  There were physical exam findings of LBP with motion, flexion in standing maneuver with pain at the end range, however sciatic testing was negative.  The examiner diagnosed lumbago.  A lumbar spine X-ray showed mild disc disease at L4-5 and L5-S1.  The chiropractor noted standing flexion was positive at the left side of the sacroiliac joint.  The lumbosacral spine MRI showed DDD at L4-5 and L5-S1; broad based central disc protrusion at L4-5 with compromise of bilateral lateral recesses to compromise the transiting S1 nerve roots and multilevel posterior facet degenerative changes.  The Electromyelogram performed for a possible lower extremity radiculopathy was normal with no evidence of a lumbar radiculopathy.  The MEB narrative summary (NARSUM) exam approximately 2 months prior to separation documented that the CI reported constant pain and an increase in intensity when standing for 10 minutes, sitting for 30 minutes, lifting, carrying, bending and crawling.  The pain would awaken the CI at night, four to five times a night.  The MEB NARSUM physical exam findings are summarized in the chart below.  The VA Compensation and Pension (C&P) exam approximately 6 months after separation documented that the CI chronic sharp burning LBP which radiated to the right leg, thigh and both feet occurred five to ten times per week and would last for 2 hours.  The CI reported one incapacitating episode in 2006, when the physician recommended bed rest with traction.  The VA C&P physical exam findings are also summarized in the chart below.

There were ROM evaluations in evidence, with documentation of additional ratable criteria, which the Board weighed in arriving at its rating recommendation; as summarized in the chart below.

Thoracolumbar ROM (Degrees)	NARSUM ~2 Mos. Pre-Sep	VA C&P ~6 Mos. Post-Sep	
Flexion (90 Normal)	60	75	
Combined (240)	145	210	
Comment	Normal gait; Pos. painful motion, tenderness to palpation, & muscle spasm; Normal strength, sensation & reflexes; Pos. straight leg raise bilat.	Normal gait; Pos. painful motion & tenderness to palpation; No muscle spasm; No Deluca criteria; Normal strength, sensation & reflexes	
§4.71a Rating	20%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the lumbar DDD without neurologic abnormality condition as 5299 analogous to 5242 (Degenerative arthritis of the spine) and rated at 10%.  The VA coded the lumbar spine DDD condition as 5242 and rated at 10%.  The General Rating Formula for Diseases and Injuries of the Spine considers the CI’s pain symptoms “with or without symptoms such as pain (whether or not it radiates), stiffness or aching in the area of the spine affected by residuals of injury or disease.”  The Board assigned exclusive probative value to the prior to separation NARSUM exam which was comprehensive and 4 months more proximate to separation as compared to the C&P exam.  The CI had a forward flexion of 60 degrees and met the 20% rating criteria for “Forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees.”  The Board considered application of code 5243 (Intervertebral Disc Syndrome) based on incapacitating episodes but no documented episodes of incapacitation that exceeded a total duration of at least 2 weeks but less than 4 weeks during the past 12 months was present in the records present for review.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the lumbar DDD without neurologic abnormality 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 did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the lumbar DDD without neurologic abnormality condition, the Board unanimously recommends a disability rating of 20%, coded 5242 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Lumbar DDD without Neurologic Abnormality	5242	20%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140421, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

SAMR-RB									

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 XXXXXXXXXXXXXXX, AR20150013454 (PD201401741)

1.  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 to modify the individual’s disability rating 20% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						     XXXXXXXXXXXXXXX										     Deputy Assistant Secretary of the Army
						         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA