RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03455
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090512

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty W2, UH-60 Pilot, medically separated for “degenerative arthritis of the lumbar spine” with a disability rating of 10%.  

CI CONTENTION:  The CI contends that he has recurring nerve pain down his arms and legs.  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 - 20090205	VARD - 20090527	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Arthritis of Lumbar Spine	5242	10%	Lumbosacral Strain with Small Disc Protrusion at L5-S1 with Mild Multilevel Degenerative Changes as Per MRI	5237	20%	20090429	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Degenerative Arthritis of the Lumbar Spine.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in August 2007 without any specific injury or trauma.  Radiographic studies showed degenerative disc disease (DDD) with a small posterior disc protrusion at L5-S1 without impingement on nerve structures.  Evaluation by orthopedics concluded with a diagnosis of low back pain.  There was no surgical indication.  Despite treatment, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military occupational specialty (MOS) and the CI was referred for MEB.  The MEB forwarded “intervertebral degenerative disc disease, lumbar” for PEB adjudication.  

The MEB NARSUM examination on 21 January 2009, 4 months prior to separation, noted complaints of back pain with prolonged standing or extended walking.  Physical examination showed decreased and painful range of motion (ROM) with forward flexion of 80 degrees (normal 90) and combined ROM of 200 degrees.  He had tenderness to palpation, but there was no mention of guarding or spasm.  Straight leg raise testing (for radiculopathy) was positive on the left greater than right, but his gait, spinal contour, motor strength, sensation, and reflexes were all normal.  

At the 29 April 2009 VA Compensation and Pension (C&P) evaluation, performed 1 month before separation, the CI reported “radiating pain with shooting painful spasm into the right side and across his back but none into the lower extremities.”  Any repetitive movements with bending, twisting, or lifting caused pain and he had difficulty with prolonged sitting or standing.  Physical examination showed guarding and painful and decreased ROM with initial forward flexion of 70 degrees decreasing to 60 degrees following repetition.  There was tenderness, but no spasm was mentioned.  Gait, spinal contour, motor strength, sensation, and reflexes were all normal.  Testing for radicular symptoms was negative.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5242 (degenerative arthritis of the spine), citing limitation of forward flexion.  The VA rated the back condition 20% coded 5237 (lumbosacral strain), based on the VA C&P examination 1 month before separation, citing limitation of forward flexion.  The Board noted that the limitation of thoracolumbar motion recorded in the MEB NARSUM examination met the threshold for a 10% rating.  However, the pre-separation VA examination was closer to separation, more detailed and reported ROM performed after repetitive motion (DeLuca).  Therefore the Board placed greater probative value on the VA examination.  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 examination proximate to separation.  There was no documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes which would provide for a higher rating under that formula (for IVDS), or evidence of ratable peripheral nerve impairment which would provide for additional rating.  

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the back condition, coded 5242.  

BOARD FINDINGS:  In the matter of the back condition, the Board unanimously recommends a disability rating of 20%, coded 5242 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Degenerative Arthritis of the Lumbar Spine	5242	20%	
The following documentary evidence was considered:
Exhibit A.  DD Form 294, dated 20140718, 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 XXXXXXXXXX, AR20160011477 (PD201403455)

1.  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, accept the Board’s recommendation to modify the individual’s disability rating to 20% without re-characterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA