RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01786
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080227

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Chemical, Biological, Radiological, and Nuclear Specialist, medically separated for “mild disc bulge at L5-S1 without neurologic abnormality,” with a disability rating of 20%.

CI CONTENTION:  The CI was not evaluated for a headache condition and his lower back condition continues to worsen and negatively impact his daily activities.   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 based on 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 - 20080922	VARD - 20081025	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Mild Disc Bulge at L5-S1 Without Neurologic Abnormality	5299-5242	20%	Mild Disc Bulge L5-S1	5243	10%	20080404	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Mild Disc Bulge at L5-S1 without Neurologic Abnormality.   According to service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back condition began in November 2005 after falling during a training exercise.  The CI’s back condition and associated right leg pain was managed conservatively over the intervening period.  A diagnostic imaging study in May 2007 showed a mild disc bulge at L5-S1 vertebra without herniation or nerve root involvement.  An electro-diagnostic study in July 2007 revealed a mild lumbosacral radiculopathy in the right medial calf muscle.  There was no surgical indication and further conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “low back pain” for PEB adjudication.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated October 2007 and January 2008, 5 months and 2 months prior to separation respectively, the CI reported constant back pain and intermittent numbness in his upper thighs.  His physical examination (PE) revealed a mild antalgic gait.  There was low back tenderness and spasms present without guarding or abnormal spinal curvature.  Range of motion (ROM) was measured with an inclinometer and was significantly decreased and painful noting forward flexion of 30 degrees.  His lower extremity strength and sensation was normal.  

At the VA Compensation and Pension (C&P) examination dated 04 April 2008, (a month after separation), the CI reported constant non-radiating back pain aggravated with prolonged sitting, standing, or repeated lifting over 35lbs.  The CI denied flare ups and or the use of any assistive devices.  His spine-focused PE was normal.  Repetitive motion testing showed no increase in pain, additional loss of function, or reduction in ROM.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating under analogous code 5299-5252 (degenerative arthritis), citing thoracolumbar ROM limited by pain and mild antalgic gait due to spasm without neurologic abnormality.  The VA assigned a 10% rating using code 5243 (intervertebral disc syndrome), citing functional loss due to pain.  The NARSUM noted that the severely limited forward flexion of the thoracolumbar ROM was obtained utilizing an inclinometer rather than the goniometric ROM as specified by the VASRD (§4.71a, Plate V).  Therefore, all Board members agreed that the VA examination held near exclusive probative value concerning ROM measurements as well as being closer to the date of separation.   IAW DoDI 6040.44, the Board may not recommend a rating lower than that received prior to application.  Therefore, all evidence considered, there is not reasonable doubt in the CI’s favor supporting a change from the PEB’s 20% rating decision for the lumbosacral spine condition.

BOARD FINDINGS:  In the matter of the lumbosacral 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 20140410, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

JUL 27 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, AR20160011075 (PD201401786)

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