RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX		CASE:  PD-2014-02281
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061203

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Power, Generation Equipment Repairer) medically separated for “degenerative disk disease of the lumbar spine,” rated at 10%.  

CI CONTENTION:  “Please consider all conditions” His complete submission is at Exhibit A.

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 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 20060908	VA* - Based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain…	5299-5237	10%	Lumbosacral Degenerative Disc Disease…	5299-5242	10%	STR	
Other MEB/PEB Conditions x 0 (Not in Scope)	Other x 0	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20070329 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Degenerative Disc Disease of the Lumbar Spine.  According to service treatment records and the MEB narrative summary (NARSUM), the CI’s back condition began in December 2004.  The CI denied any specific injury or trauma.  Radiographic studies showed degenerative disc disease.  Electrodiagnostic studies (EMG/NCV), 10 April 2006, were negative for radiculopathy.  There was no surgical indication.  Some clinic evaluations documented limited back motion, decreased sensation in the left leg, and decreased reflexes in the right leg. 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 Medical Evaluation Board (MEB).  At the time of the neurology clinic appointment on 10 April 2006, (8 months prior to separation), the examiner recorded complaints of chronic lower back pain with radiation into right thigh for 6 months, including intermittent numbness to the right lower leg and foot.  There was only rare numbness in the left leg, but no pain.  On examination, electrodiagnostic studies (EMG/NCV) were negative for radiculopathy.  At the MEB examination (recorded on DD Form 2807 and 2808) dated 17 May 2006, (7 months prior to separation), the CI reported constant sharp stabbing pains in the lower back with numbness in both legs making it hard to walk, stand-up, crouch down or drive.  Physical exam showed back tenderness to palpation, no spasm, positive bilateral straight leg raise (indicating potential radiculopathy), decrease light touch sensation, normal reflexes with normal strength and normal gait.  At the time of the orthopedic spine clinic appointment on 18 May 2006 (7 months prior to separation), the examiner noted CI’s complaints of intermittent back pain radiating to the right thigh with occasional tingling in the right foot; pain with lifting; and inability to tolerate the wear of his protective vest.  On examination, there was thoracolumbar tenderness to palpation and “decent ROM (range-of-motion) with pain.”  Straight leg raise testing (for radiating symptoms) was equivocal on the right and negative on the left.  There was “subjective decreased pinprick (numbness) in the L4/5 distribution but present.”  Reflexes, strength and motor function were normal.  The MEB NARSUM, dated 19 June 2006 (6 months prior to separation) noted complaints of chronic low back pain.  Physical exam cited the 18 May 2006 orthopedic clinic exam above and included normal distal vascular exam and normal heel and toe walk and was summarized as showing mild lumbar tenderness to palpation, normal strength bilaterally, normal sensation to touch bilaterally with subjective numbness (decreased pinprick in the L4-L5 distribution), full active range-of-motion, positive bilateral straight leg testing (for radiating symptoms and normal gait.  There was no VA Compensation and Pension (C&P) exam performed proximate to separation.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the analogous 5237 code (lumbosacral strain), citing localized tenderness.  The VA also assigned a 10% rating using the analogous 5242 code (degenerative arthritis of the spine) based on Service medical records, citing slightly limited lumbar motion, muscle spasms, tenderness, and radiological studies which substantiated the presence of degenerative changes and disc bulging of the lumbar spine.  The Board agreed a 10% rating was justified for the presence of painful motion and tenderness.  There was insufficient documentation of limited ROM to support a rating higher than 10%.  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.  The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI had degenerative disc disease with radicular pain and intermittent numbness, and there were symptoms of radiating pain and decreased sensory exams documented in the treatment records; however, examinations indicated normal strength, reflexes and gait and the sensory changes did not affect his job.  The presence of functional impairment with a direct impact on fitness is the key determinant in the Board’s decision to recommend any condition for rating as additionally unfitting.  While the CI may have suffered additional pain from the nerve involvement, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  Therefore the critical decision is whether or not there was a significant motor weakness which would impact military occupation specific activities.  There is no evidence in this case that motor weakness existed to any degree that could be described as functionally impairing.  The Board therefore concludes 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 back condition.  

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 20140519, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-00), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXXXXX AR20160004383 (PD201402281)

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