RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03423
BRANCH OF SERVICE:  Army                                                            SEPARATION DATE:  20090227 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, Unit Supply Specialist, medically separated for “intervertebral disc syndrome of the lumbar spine,” with a disability rating of 20%.  

CI CONTENTION:  “Please consider 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 based upon a 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 - 20081217	VARD - 20090604	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Intervertebral Disc Syndrome of the Lumbar Spine	5243	20%	Degenerative Disc Disease, Lumbosacral Spine	5242	10%	20090325	
Refractive Error	Not Unfitting 	No VA Placement	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Lumbar Intervertebral Disc Syndrome.  The service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM) documented an atraumatic onset of low back pain in 2005 during basic training.  There was no STR documentation of persistent radiation or any neurological symptoms.  Imaging (MRI) from October 2006 demonstrated “minimal” disc disease (L4/5 without neural compromise).  Multiple normal neurological examinations were evidenced in the STR, with no findings to the contrary.  There were entries that noted grossly normal range of motion (ROM) or non-specifically decreased ROM, with no entries suggesting severe limitation.  There was STR documentation of normal gait and normal spinal contour, with no evidence to the contrary; and, there was no STR documentation of incapacitating episodes.  Surgery was considered and deferred; conservative treatment did not result in sufficient improvement to allow unrestricted duty; and, the CI was referred for an MEB which in turn forwarded “lumbago” to the PEB.
  
The NARSUM examination was conducted on 6 October 2008, 6 months before separation, and was supplemented by a neurosurgical addendum of 11 July, 3 months earlier.  The neurosurgeon documented “no neurological signs or symptoms ... able to walk normal distances without assistance” and recorded a normal neurological examination.  The NARSUM examiner documented pain rated 8/10 “worse with stretching, lifting, walking more than 100 meters, or lying on the floor.”  The physical examination recorded a normal spinal contour, guarding and tenderness, and normal neurological findings with 5/5 bilateral strength.  Measured ROM was flexion to 35 degrees (normal 90) with combined ROM of 165 degrees (normal 240).  

A VA Compensation and Pension (C&P) examination on 25 March 2009, 1 month after separation, documented back pain rated 8/10 “without radiculopathy”, but “able to perform the usual activities of daily living ... [and] ... no periods of acute incapacitation.”  The physical examination recorded a normal gait, the absence of spasm or tenderness, and normal neurological findings.  Measured ROM was normal (flexion 90 with combined 240 degrees), but specified “mild” painful motion with flexion.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the condition 20% under code 5243 (intervertebral disc syndrome), citing the NARSUM flexion.  The VA’s 10% under code 5242 (degenerative arthritis of the spine) was premised on the C&P ROM evidence and cited painful motion.  There was no ROM evidence supporting a rating higher than 20%, no evidence of additionally ratable peripheral nerve impairment, and no documentation of incapacitating episodes that would provide for a higher rating under that formula.  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 of the lumbar spine condition.

Contended Condition:  Refractive Error.  The CI required full-time use of glasses for myopia with vision corrected to 20/20 (OS/OD/OU).  The profile was E1; the condition was not implicated by the commander; and, it was forwarded to the PEB as medically acceptable.  The Board’s main charge was to assess the fairness of the PEB’s determination that the condition was not unfitting.  The Board agreed there was no performance-based evidence indicating that the condition interfered with duty requirements.   After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the corrected refractive error.

BOARD FINDINGS:  In the matter of the lumbar spine condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended vision condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  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 20140722, 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

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160017186 (PD201403423)

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