RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03558
BRANCH OF SERVICE:  Army	                        SEPARATION DATE:  20070705

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Network Switching Systems Operator-Maintainer, medically separated for “lumbar degenerative disc…,” with a disability rating of 10%.  

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 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 - 20070517	VARD - 20071019 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar Degenerative Disc Changes…	5242	10%	Degenerative Disc Disease, Lumbar Spine, with Residuals	5243	10%	20071019	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Lumbar Spine.  Absent direct trauma, the CI developed low back pain (LBP) in 2004 and had intermittent flare-ups of the same throughout the remainder of his military career.  X-ray evaluation revealed multi-level degenerative changes in the lumbar spine.  His condition was non-surgical and the mainstay of treatment was physical therapy (PT), medications, restrictions, and local/systemic injection therapy.  He was permanently profiled in February 2007 and referred to a Medical Evaluation Board.  At the narrative summary examination (24 April 2007; 2 months prior to separation) the CI’s chief complaint was, “chronic lower back pain.”  Physical examination (PE) revealed tenderness, guarding, and painful motion of the lumbar spine.  Thoracolumbar range of motion (ROM) was decreased, but flexion and extension parameters were measured with an inclinometer and thus not in compliance with VASRD standards.  There were no spasms, altered gait, or abnormal spinal contour present.  All neuro sensory and motor components were intact.  The final diagnosis remained chronic lower back pain secondary to lumbar disc disease.  At the VA Compensation and Pension (C&P) examination (17 August 2007; a month after separation), the CI endorsed continued LBP.  His PE revealed minimal, but painful thoracolumbar ROM.  All other parameters of a detailed examination were normal.  The ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Thoracolumbar ROM
(Degrees)	PT ~2 Mo. Pre-Sep
(20070404) 	VA C&P ~4 Mo. Post-Sep
(20070817) 	
Flexion (90 Normal)	(50) 50 50 55: (inclinometer)	85	
Extension (30)	(10) 10 10 10
(inclinometer)	25	
R Lat Flexion (30)	(10) 10 5 10	30	
L Lat Flexion (30)	(15) 15 15 15	30	
R Rotation (30)	(30) 30 30 30	30	
L Rotation (30)	(30) 45 45 45	30	
Combined (240)	145	230	
Comment	guarding; tenderness	painful motion	
§4.71a Rating	20%	10%	

The Board directed attention to its rating recommendation based on the above evidence. Utilizing similar VASRD codes of (5242 and 5243), both the PEB and VA rated the low back condition at 10% citing the presence of pain/guarding and or limiting motion.  Board members first considered examination probative value (PV) in this case and concluded that the 4 month post separation VA exam be apportioned near exclusive PV due to the PT’s non-compliance in ROM measurements by using an inclinometer vice a goniometer.  Absent compensable ROM parameters, the PV examination revealed sufficient evidence of painful motion to justify the Service rating of 10% IAW VASRD §4.59.  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 low back condition.

BOARD FINDINGS:  In the matter of the low back 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 20140728, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

18 AUG 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 XXXXXXXXXXXXXXXXXX, AR20160008184 (PD201403558)

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.

				         
Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA