RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02624
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090329

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Information Technology Specialist Trainee, medically separated for “degenerative arthritis, lumbar spine” with a disability rating of 10%.

CI CONTENTION:  “I was medically separated for degenerating discs in my lower back.  The discs bulge into nerves, and have caused constant pain since before discharge.  I am unable to perform many things that a typical 28 year old can, like stand or sit for any length of time, without serious pain.”  The applicant’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  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 - 20090127	VARD - 20090928	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Arthritis, Lumbar Spine	5242	10%	Multiple Level Degenerative Disc Disease, Lumbar Spine with Right Sciatica	5242	20%	20090702	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Degenerative Arthritis, Lumbar Spine.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s lumbar spine condition began in 2003 during basic training for a prior enlistment in a different military service.  No specific trauma or injury was identified.  The CI enlisted in the Army in 2008, and the back pain resurfaced during advanced individual training in May 2008.  Radiographic studies in November 2008 showed bulges in two intervertebral discs in the low back and evidence of a tear in the fibrous exterior lining of one of those discs.  There was no surgical indication.  Despite conservative treatment, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and he was referred for an MEB.  The MEB forwarded “chronic uncomplicated low back pain likely secondary to disk protrusions at L4/5” to the PEB for adjudication.

At the time of a primary care clinic examination on 12 November 2008, 5 months before separation, the CI reported nagging back pain rated 3/10 in severity that did not radiate.  On examination, painful motion and spine tenderness were present, but gait and spinal contour were normal.  Lumbosacral spine range of motion (ROM) was “full” but measurements were not provided.  Provocative testing for nerve root irritation was negative.  The CI could perform a full squat with mild pain on returning to a standing position.

During a physical therapy appointment on 2 December 2008, 4 months before separation, the CI denied radiating pain.  The examination revealed tenderness and painful motion.  Spinal contour and gait were normal.  Lumbosacral motion was noted as “full range.”  There was no sign of nerve root irritation.  At the MEB examination (recorded on DD Form 2808) dated 12 December 2008, the examiner reported decreased ROM of the lumbosacral spine which was characterized as “slight.”  The MEB NARSUM examination on the same day noted complaints of chronic daily pain aggravated by prolonged standing, bending, twisting, or carrying more than 15 pounds.  Radiating pain was denied.  The examination showed a normal gait and spinal curvature.  There was no muscle spasm or tenderness.  Thoracolumbar flexion was 90 degrees (normal 90) and combined ROM was 240 degrees (normal 240).  The presence of painful motion was implied in one section of the report, but was recorded as absent elsewhere in the evaluation.  Evidence of nerve root irritation was absent.  Lower extremity strength and sensation were normal.

At the VA Compensation and Pension (C&P) examination on 2 July 2009, 3 months after separation, the CI reported chronic low back pain rated 6-7/10, with intermittent pain down his right leg to the knee.  He denied numbness or tingling in the toes of either foot.  The back pain was aggravated by prolonged sitting and resulted in an inability to drive long distances.  At times, the pain in his right leg was severe enough to prevent full weight bearing on that leg.  The examination showed no limp during ambulation and spinal contour appeared normal.  Spine tenderness and painful motion were present.  Thoracolumbar flexion was 40 degrees but combined ROM could not be calculated because rotation was not assessed.  Testing for nerve root impingement was negative.  Repetitive motion resulted in increased pain and fatigue, but there was no documentation of any change in ROM.  Lower extremity muscle strength and sensation were not tested.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10% coded 5242 (degenerative arthritis of the spine), citing painful motion.  The VA rated the condition at 20% also coded 5242 based on the VA C&P examination 3 months after separation, citing limitation of forward flexion.  Although there was no limitation of motion reported by the service exams, the Board agreed there was sufficient evidence to recommend a 10% rating for painful motion and tenderness.  There was no muscle spasm or guarding severe enough to result in abnormal gait or spinal contour to recommend a higher 20% rating on these bases.  While the VA examination supported a 20% rating based on limitation of forward flexion (greater than 30 degrees but not greater than 60 degrees), this examination was judged by the Board to be of lower probative value for the following reasons: (1) the lack of an assessment by the C&P examiner of all ROM parameters as required by the VASRD; (2) the rather dramatic reduction in ROM compared to all pre-service exams without any explanation for such an interval change (e.g. re-injury); and (3) the inter-observer consistency present on the pre-separation examinations.  The Board therefore, relying more heavily on the service examinations, concluded that a 10% rating was appropriately assigned in this case.  There was no evidence of intervertebral disc syndrome (IVDS) which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula (for IVDS).  There was likewise no evidence of an associated unfitting radiculopathy for consideration of a separate peripheral nerve rating.  After due deliberation, and in consideration of all 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.

BOARD FINDINGS:  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.  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 20140528, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

JUL 1 9 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 XXXXXXXXXX, AR20160008551 (PD201402624)

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