RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02003
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090723

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated Reserve E4, Human Resources Specialist, medically separated for “degenerative arthritis, lumbar spine with a disability rating of 20%.  

CI CONTENTION:  She was given a higher rating for her condition by the VA.  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 - 20090515	VARD – 20090513 (PROPOSED)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Arthritis, Lumbar Spine	5242	20%	Lumbar Degenerative Disc Disease and Degenerative Joint Disease	5242	20%	20090227	
Migraine Headaches	Not Unfitting	Migraine Headaches	8100	0%		
GERD	Not Unfitting	GERD	7346	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Degenerative Arthritis, Lumbar Spine.  The Service adjudicated this case as part of the Pilot Disability Evaluation System under the policy and procedure Directive-Type Memorandum (DTM) of 21 November 2007.  

According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in 2007 attributed to mounting, dismounting and riding in vehicles as well as usage of her gear.  A magnetic resonance imaging performed on 9 December 2008, showed mild disc facet disease with no disc herniation or never root impingement.  Radiographic study February 2009 was normal.  There was no surgical indication.  Despite treatment, the CI’s back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and was referred for a MEB.  The MEB forwarded “chronic low back pain due to DDD [degenerative disc disease] at L3 through L5” for PEB adjudication.  

At the time of the physical therapy clinic appointment on 2 January 2008, the CI reported she continued to experience 2-4/10 low back pain (LBP).  On examination there was tenderness to palpitation (TTP) and spasms were present.  Straight leg raise (SLR) testing for radiculopathy was negative.  The range of motion (ROM) was forward flexion of 40 degrees (normal 90).  At the chiropractic clinic appointment on 8 January 2008, the CI reported 4/10 LBP.  On examination there was TTP.  Posture, sensation and muscle strength was normal.  There was no radiation of pain into the lower extremities and SLR testing for radiculopathy was negative.  The ROM was forward flexion of 40 degrees with sharp pain.  During the physical therapy clinic appointment on 23 July Month 2008 the CI reported baseline pain 5/10 which increased to 9/10 constant and throbbing when using an elliptical.  On examination the lumbar and thoracic spine revealed TTP.  The spine demonstrated no abnormal contour or muscle spasms.  SLR testing for radiculopathy was negative.  The ROM was normal with pain through the ROM.  

At the VA Compensation and Pension (C&P) examination on 27 February 2009, performed 5 months before separation, the CI reported constant 1-8/10 LBP which traveled to her legs without numbness and she stated “her condition has not resulted in any incapacitation.”  On examination her posture and gait were normal and there were no spasms.  There was no radiating of pain on movement.  SLR testing for radiculopathy was negative.  TTP was noted.  The ROM was forward flexion of 50 degrees with a combined ROM of 150 degrees (normal 240) additionally limited by 5 degrees by painful motion.  There was no weakness and there were “no signs of lumbar intervertebral disc syndrome with chronic and permanent nerve root involvement.”  

The NARSUM stated “This DES Pilot Narrative Summary is based on a review of medical records and physical examination performed by the VA …,” and findings were taken directly from the VA C&P examination.  

The Board directed attention to its rating recommendation based on the above evidence.  The VA proposed rating for the condition was 20% coded 5242 (degenerative arthritis of the spine), based on the VA C&P examination 5 months before separation, citing limitation of forward flexion.  The PEB followed the VA rating (IAW the Pilot DES DTM) and the PEB rated the back condition 20% coded 5242 (degenerative arthritis of the spine), citing limitation of forward flexion.  Subsequent VARDs show no change from the VA’s proposed rating of 20%.  The Board agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees), reported on the chiropractic, NARSUM and VA examinations.  

There were no incapacitating episodes requiring bed rest prescribed by a physician to warrant consideration of rating under the alternate VASRD formula based on incapacitating episodes due to intervertebral disc syndrome.  There was no associated radiculopathy for separate peripheral nerve rating.  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 impairments such as weakness with a direct impact on fitness that were separately functionally impairing for duty.  The Board therefore concluded that 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 degenerative arthritis, lumbar spine condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the migraine headaches and gastroesophageal reflux disease (GERD) conditions were not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The migraine headaches condition was profiled beginning in February 2009 and was judged to fail retention standards by the NARSUM and MEB, but was not implicated in the commander’s statement.  Migraines were noted to start in 2008 with a March 2008 treatment note.  The second treatment note for headache was in October 2008, and indicated symptoms of nausea and vomiting, requiring injected medication and 48 hours of quarters.  There were no other treatment records for migraine headache.  The pre-separation VA exam and NARSUM noted a report of “headaches associated with nausea, severe enough to affect functioning.  When headaches occur she has to stay in bed and is unable to do anything.”  The CI reported headaches on the average of 3 times a week lasting for 45 minutes with nausea, and that the CI had missed some formations due to headaches.  Treatment was Midrin (pain reliever and fever reducer) as needed.  The CI reported “that she does not experience any functional impairment from this condition.”  Neurologic exam was normal.  Headaches were not adjudged to be prostrating by the VARD dated 27 February 2009.  The GERD condition was not profiled or implicated in the commander’s statement and was not judged to fail retention standards.  All were reviewed and considered by the Board.  There was no performance based evidence from the record that either of these conditions significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the any of the contended conditions and so no additional disability ratings are recommended.  

RECOMMENDATION:  In the matter of the degenerative arthritis, lumbar spine condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended migraine headaches and GERD conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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 20140321, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXX, AR20160007468 (PD201402003)

I have reviewed the enclosed Department of Defense Physical Disability Board of
Review (000 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