RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02616
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070201

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Infantryman, medically separated for “chronic back pain due to lumbar degenerative disc disease without neurologic abnormality” with a disability rating of 10%.  

CI CONTENTION:  The CI requested consideration of all conditions. 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 - 20061201	VARD - 20070705	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain Due to Lumbar Degenerative Disc Disease, Without Neurologic Abnormality	5099-5242	10%	Lumbar Degenerative Disc Disease	5242	10%	20070406	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Back Pain Due to Lumbar Degenerative Disc Disease (DDD).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back pain condition began in March 2006 after lifting boxes.  Radiographic studies showed he had degenerative disc disease (DDD) at L3 thru S1.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “lumbar degenerative disc disease” for PEB adjudication.  
The MEB NARSUM examination on 16 November 2006, 3 months prior to separation, the CI complained of back pain that was constant, throbbing in nature, and which radiated up his spine to his neck and associated with headaches.  He stated that his symptoms worsened with stress, bending, lifting, running, prolonged sitting, walking long distances, and was associated with muscle spasms and sometimes headaches.  He also reported that he had marked stiffness in the morning.  The physical examination showed tenderness to palpation (TTP) and some muscle spasm.  Motor, sensory and reflex testing were normal and provocative testing for radiculopathy was negative.  

At the time of the physical therapy (PT) examination on 27 November 2006, the examiner recorded range of motion (ROM) measurement with an inclinometer (except for rotations) after repetition as:  active flexion to 60 degrees (normal 90), and combined ROM of 185 degrees (normal 240).  Limitation of motion was due to pain.  There was muscle spasm and guarding without localized tenderness.  There was no abnormal gait or contour due to muscle spasm or guarding.  

At the 6 April 2007 VA Compensation and Pension (C&P) evaluation, performed 2 months after separation, the CI reported daily back pain.  Bending over and lifting aggravated his pain.  There was no radiation of pain into the lower legs.  The pain waxed and waned, and was a 3-4 out of 10.  He did not wear a brace, and did not use a cane or assistive devices.  Physical examination showed ROM forward flexion to 80 degrees, and combined 230 degrees.  Neurologic examination was normal.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back pain condition 10%, coded 5099-5242 (degenerative arthritis of the spine), citing painful limitation of motion and tenderness.  The VA rated the back pain condition 10% coded 5242 (degenerative arthritis of the spine) based on the VA C&P examination 4 months after separation, citing limitation due to pain.  The Board noted that the limitation of thoracolumbar flexion (60 degrees after repetition) reported in the PT MEB ROM examination suggested consideration of the next higher rating of 20%; however, the examiner specified forward flexion was measured using an inclinometer rather than a goniometer as required in the VASRD (§4.46, accurate measurement).  Board members agreed that the VA examination, performed about the same time relative to separation, was more detailed and compliant with VASRD rating guidelines.  Therefore the Board placed greater probative value on the VA examination.  

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) reported on the VA examination, 2 months proximate to separation.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes which would provide for a higher rating under that formula (for IVDS).  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 impairment (such as weakness) that directly impacted fitness for duty.  The Board therefore concluded that an 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 pain condition.  

BOARD FINDINGS:  In the matter of the back pain 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 20140527, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

27 JUL 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, AR20160011308 (PD201402616)

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