RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02192
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090226

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Power Generation Repair, medically separated for “lumbar intervertebral disk syndrome,” with a disability rating of 10%.  

CI CONTENTION:  “Please consider all conditions”  

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: 

IPEB – Dated 20081120	VA* - (~2 Mos. Pre-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar Intervertebral Disk Syndrome	5243	10%	Degenerative Disc and Joint Disease of the Lumbar Spine	5242	10%	20081212	
Other x 0 (Not In Scope)	Other x 5	
RATING:  10%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20090521 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Lumbar Intervertebral Disk Syndrome.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in August 2007 after heavy lifting and later reinjured during combatives training in April 2008.  At the time of a 30 April 2008 clinic visit he reported occasional stinging in the leg.  On exam he was noted to have pain with flexion and extension, no pain to palpation, and a normal motor exam. Magnetic resonance imaging (MRI) showed degenerative disc disease with small disc protrusions or small herniations (at the L4-5 and L5-S1 levels).  At the time of a civilian neurosurgery consultation on 29 July 2008 (7 months prior to separation) the examiner noted mild pain on palpation and good range of motion (ROM) with motor and sensory exams intact.  He reviewed the MRI noting there was no surgical indication and recommended continued physical therapy.  At the time of a physical therapy clinic appointment on 1 August 2008 (7 months prior to separation), the examiner noted a normal gait, mostly full ROM with mid to end range pain with flexion and extension.  Despite physical therapy and chiropractic manipulation, the CI’s back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and so he was referred for a Medical Evaluation Board (MEB).  

At the MEB examination (DD 2807 & 2808) on 24 October 2008 (4 months prior to separation), the CI indicated that he had numbness or tingling, constant 4 of 10 pain that increased to 10 of 10 with: lifting, overhead activities, bending, straightening his lower back, wearing field equipment, and with any impact activities, but the examiner noted a normal gait and that he was able to lift a 25 pound box without pain or grimace.  On examination there was minimal tenderness and spasm but gait and spinal contour were normal.  Examination maneuvers for signs or symptoms of radiculopathy were negative.  

At the VA Compensation and Pension (C&P) examination on 12 December 2008 (2 months prior to separation), the examiner noted that the CI developed progressive lower back pain after a right hip fracture that occurred during basic training in 2006.  The CI stated that he has radiating pain to the right leg when bending over, but the pain resolves when he stands up.  The CI also stated that he has spasms when he is more active, but no spasms were noted by the examiner.  On examination, there was painful motion with limitation of motion.  There was no muscle spasm and gait and spinal contour were normal.  Examination maneuvers for signs or symptoms of radiculopathy were negative.  At the time of a VA physical medicine consult on 17 August 2009 (6 months post-separation) the CI was employed as a maintenance officer.  The back pain was aggravated by activities including bending and lifting and the CI complained of numbness and tingling in both legs to feet and toes with bending.  The examiner noted normal ROM, and normal strength.  At the time of a VA clinic visit on 15 December 2009 (10 months post-separation), The examiner noted tenderness, normal strength and ROM, and examination maneuvers for signs or symptoms of radiculopathy were negative. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 5243 code (intervertebral disk syndrome), citing painful motion.   The VA also assigned a 10% rating using the 5242 code (degenerative arthritis of the spine) for limitation of forward flexion, limitation of combined range of motion, and tenderness.  The Board agreed that a 10% rating, but no higher, was justified for limitation of flexion greater than 60 degrees but not greater than 85 degrees and combined ROM greater than 120 degrees but not greater than 235 degrees as reported on the NARSUM, MEB, and VA exams.  There was no muscle spasm or guarding severe enough to result in abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no evidence of intervertebral disc syndrome resulting in 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.  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 back condition.

BOARD FINDINGS:  In the matter of the 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 20140515, 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
(AH RC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXX, AR20160008541 (PD201402192)

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