RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03375
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080427

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E-4, Motor Transport Operator, medically separated by the Informal PEB (PEB) for “lumbar degenerative disc disease” with a disability rating of 10%. 

CI CONTENTION:  “Please consider all conditions.”  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 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:  

SERVICE PEB - 20080229	VARD - 20081128	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar Degenerative Disc Disease	5299-5242	20%	Degenerative Disk Disease, Lumbar Spine	5242	20%	20080915	
			Right … Radiculopathy … 	8599-8520	NSC	20080922	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Lumbar Degenerative Disc Disease Condition.  According to service treatment records and the MEB narrative summary (NARSUM), the CI’s lower back condition began in October 2006 after doing annual fitness testing.  The CI denied any specific injury or trauma.  In addition to back pain, she complained of weakness and sensory decrease of the right leg.  Radiographic studies showed extremely marked degenerative changes at L5-L1.  Further electrodiagnostic studies (EMG/NCV) in November 2006, were abnormal indicating a nerve root or plexus injury (radiculopathy).  There was no surgical indication.  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).  Thoracolumbar range-of-motion (ROM) measurements performed by physical therapy on 4 October 2007, 7 months prior to separation were flexion of 35, 35, 32 degrees (normal 90) on repetitions and combined ROM 140 degrees (normal 240) with painful motion (an inclinometer versus a goniometer was used for measurements).  The exam also documented tenderness; reduced spine curves and no abnormal gait due to spasm or guarding.  The MEB NARSUM exam on 15 November 2007 (5 months prior to separation) noted complaints of intermittent back pain ranging from sharp to dull to stabbing with right lower extremity radiculopathy that comes and goes with intermittent leg weakness.  Symptoms were aggravated by walking, standing, and impact activities, lifting, sitting, and daily activities.  Physical exam showed tenderness with muscle spasm (gait and spinal contour were not noted).  Straight leg raise test (for radiating symptoms) was positive on the left.  The motor and reflex exams were normal.  There was mildly decreased sensation in the medial thigh and calf on the left, with an otherwise normal sensory exam.  At the VA Compensation and Pension (C&P) examination on September 2008, performed 5 months after separation, the CI reported chronic pain, soreness, tenderness, some limited endurance and right sciatic pain.  Symptoms were aggravated by prolonged standing and walking.  Physical exam showed thoracolumbar tenderness with flexion of 45 degrees (normal 90) and combined ROM 145 degrees (normal 240).  There was no back spasm or lumbar deformity.  There was no lower extremity weakness or clinically significant sensory deficits.  Electrodiagnostic testing was incomplete due to the CI not tolerate any needle electrode examination and asked to stop the test.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating under an analogous 5242 code (degenerative arthritis of the spine), citing exam tenderness and spasm with painful limitation of motion and weakness with use.  The VA also assigned a 20% rating using the 5242 code based on the VA C&P examination 5 months after separation, citing limitation of forward flexion.  The VA adjudged a claimed lumbar radiculopathy and sciatica of the right lower extremity (8599-8520) as not service connected, citing no evidence of the condition.  

The Board deliberated on the probative value of the exams in evidence and the totality of the record.  The documented limitation of flexion at the PT exam of flexion of 30 degrees following repetition (after applying the VASRD spine formula notes for rounding), was the single piece of data in the record that reached the 40% criteria for forward flexion of the thoracolumbar spine 30 degrees or less.  However, the exam was using an inclinometer, the preponderance of the record did not approach this disability level, and the more proximate VA exam was adjudged to have the highest probative value for rating at separation.  The Board agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees) reported on the VA exam.  There was no documentation of incapacitating episodes which would provide for a higher rating under that formula.  The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI had symptoms of right leg radiating pain, sensory loss and weakness documented in the treatment records with abnormal electrodiagnostic testing in 2006 through early 2007.  However, by the time of separation examinations indicated normal strength, and reflexes with only mild sensory deficits.  By the time of the VA exam, there were no documented motor or sensory deficits.  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 or sensory deficit 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 lumbar degenerative disc disease condition.  

BOARD FINDINGS:  In the matter of the lumbar degenerative disc disease 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 20140423, 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
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

JUL 1 4 2016

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXX, AR20160005137 (PD201403375)

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
( ) OVA