RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03126
BRANCH OF SERVICE:  coast guard 	SEPARATION DATE:  20041227

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-2 (Seaman Apprentice) medically separated for intervertebral disk syndrome, rated at 10%.

CI CONTENTION:  The applicant asks that all conditions be considered.  His 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 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 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 20041104	VA* - Based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Intervertebral Disk Syndrome Forward Flexion…	5243	10%	Degenerative Disc Disease of Thoraco-lumbar Spine, HNP of T12-L1, L5-S1	5243	0%	STR	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 0	
RATING:  10%	RATING:  0%	
*Derived from VA Rating Decision (VARD) dated 20061005(most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Intervertebral Disk Syndrome.  The narrative summary (NARSUM) and record noted the CI had an injury with onset of low back pain (LBP) in April 2006.  He had pain, numbness and tingling into the left lower leg (LLE).  X-rays were normal and an MRI documented a small disc protrusion at L5-S1 causing significant narrowing that aligned with his LLE symptoms, as well as other thoracolumbar spine findings noted in the MEB diagnoses above.  The CI had physical therapy (PT) with temporary relief following epidural steroid injections, systemic steroids and narcotic pain medication.  A CT myelogram in July 2004 documented HNP at L4-L5 and L5-S1 impinging on the nerve root.  The CI underwent left L5-S1 microlumbar discectomy in August 2004.  Neurosurgical follow-up from 26 October 2004 (8 week post-surgery; 2 months pre-separation) documented the CI indicated he was “virtually pain-free.”  Lumbar exam documented tenderness, well healed incision, “full range of motion,” no dermatomal sensory deficit and a non-antalgic gait.  PT range-of-motion (ROM) evaluation on 29 October 2004 documented ROM of forward flexion of 80 degrees (normal 90) and combined of 215 degrees (normal 240).  

There was no VA Compensation and Pension (C&P) exam performed proximate to separation.  The first VA exam in evidence was dated September 2009, over 4 years remote from separation, and was after a reported motor vehicle accident in August 2009.  Subsequent VARDs documented increased back ratings, addition of a rating for LLE and RLE radiculopathies and addition of a back scar rating.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the chronic back condition as 5243 (Intervertebral disc syndrome) rated at 10% citing VASRD forward flexion ROM criteria.  There was no VA documentation proximate to separation and the remote VA exam was following a post-separation injury.  Neurosurgeon findings of tenderness and PT ROM findings both supported a 10% rating IAW the “General Rating Formula for Diseases and Injuries of the Spine.”  The spine formula considers the CI’s pain symptoms “with or without symptoms such as pain (whether or not it radiates), stiffness or aching in the area of the spine affected by residuals of injury or disease.”  The CI met the 10% rating criteria for tenderness, ROM for forward flexion, or for combined ROM.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour, and no more limited ROM to support any rating above 10%.  There was no evidence of incapacitating episodes for alternative rating under the formula for rating intervertebral disc syndrome based on incapacitating episodes.  The Board considered whether additional Service rating could be recommended under a peripheral nerve code for potential residual pain in the left foot.  However, the evaluation indicated the CI was “virtually pain-free” and had no objective peripheral nerve findings.  The pain component of a radiculopathy is subsumed under the general spine rating as specified in §4.71a.  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 “intervertebral disk syndrome … ” condition or for addition of any peripheral nerve rating.  

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the “intervertebral disk syndrome …” 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 20140625, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

Commandant
United States Coast Guard	Mail Stop 7907
2703 Martin Luther King Jr. Ave SE
Washington, DC 20593-7907
Staff Symbol: CG-1
Phone: (202) 475-5000

								   XXXX

Dear XXXXXXXXXX,
I am the Designated Decision Authority for the Coast Guard on applications submitted to the Department of Defense Physical Disability Board of Review (PDBR).  Under the authority of Title 10, United States Code, section 1554a, I accept the PDBR’s recommendation in your case (Case Number PD-2014-03126) and decline to modify your findings. 

Enclosed for your information are a copy of the PDBR’s recommendation and a copy of the record of proceedings. 

A copy of this decision has also been provided to Coast Guard Enlisted Personnel Management Branch, the PDBR, and the Department of Veterans Affairs. 

If you have any further questions, please contact the Coast Guard Personnel Service Center at (703) 872-6628. 
	Sincerely,
2 Enclosures		
	
Copy:	CG Personnel Service Center (EPM-1)
DoD Physical Disability Board of Review
Department of Veterans Affairs