RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03897
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20081120

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Cannon Crewmember, medically separated for “degenerative arthritis, lumbar spine,” with a disability rating of 10%.

CI CONTENTION:  “Please consider all conditions.”  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 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 on 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 - 20080804	VARD - 20090303	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Arthritis, Lumbar Spine	5242	10%	Chronic Back Pain - Lower Lumbago, Intervertebral Disc Degeneration L5-S1, Disc Narrowing at T12 - L1	5243	40%	20080929	
Adjustment Disorder	Not Unfitting	Acquired Psychiatric Disorder to include Adjustment Disorder with Mixed Emotional Features of Anxiety and Depression	9413-9433	10%	20080929	
Bronchitis	Not Unfitting	Bronchitis	6600	NSC	20080929	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:

Lumbar Spine.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s lumbar spine condition began in April 2007 during a field exercise when he slipped and twisted his lower back.  Magnetic resonance imaging of the lumbar spine on 20 July 2007 showed mild degenerative changes of L5-S1.  There was no surgical indication and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic low back pain” for PEB adjudication.

During the 6 November 2008 MEB physical therapy (PT) examination, 12 months before separation, the physical examination revealed a normal gait and spinal contour.  There was spinal tenderness and muscle spasms.  The range of motion (ROM) for flexion was 50 degrees (normal 90 degrees) and the combined ROM was 150 degrees (normal 240 degrees) with painful motion.

At the MEB PT examination on 20 May 2008, 6 months prior to separation, the CI complained of burning low back pain rated at 6/10, and numbness and tingling in the left leg.  He denied associated fatigue, weakness, lack of endurance, instability or incoordination.  He reported weekly flare-ups to 8/10 where he was unable to work.  The physical examination documented a normal gait with spinal tenderness, muscle spasm, and guarding, but no abnormal contour.  The goniometric-repetition ROM was flexion of 70 degrees and combined ROM of 190 degrees with painful motion.

The 10 July 2008 MEB NARSUM examination, 4 months prior to separation, noted complaints of daily low back flare-ups usually lasting a few hours.  Exacerbating factors included exertion, prolonged walking, and lifting.  The physical examination showed thoracic, lumbar, and para lumbar muscle tenderness, and an antalgic gait due to pain and guarding.  Straight leg raise (SLR) tests (for herniated discs causing sciatic nerve root [L5-S1] radiculopathy) were negative, and strength, sensation, and deep tendon reflexes were normal.  There was pain with ROM, but no measurements were documented.

At the 29 September 2008 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported constant pain, weakness, stiffness, fatigue, and lack of endurance of the lumbar spine.  The physical examination documented a normal gait.  There was tenderness at vertebrae and paravertebral muscles, without muscle atrophy or overt deformities.  The SLR tests were negative with normal strength, sensation, and reflexes.  The ROM measurements were flexion of 50 degrees and combined ROM of 160 degrees with painful motion.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating, coded 5242 (degenerative arthritis of the spine), citing tenderness, spasm, and guarding, forward flexion of 69 degrees, and a combined ROM of 195 degrees.  The VA assigned a 40% rating, coded 5243 (intervertebral disc syndrome), based on the VA C&P examination 2 months before separation, citing forward flexion of the thoracolumbar spine of 30 degrees or less or favorable ankylosis of the entire thoracolumbar spine.  The Board considered the disparity of the ROM values found in the PT and VA C&P examinations.  The first PT examination (flexion 50) supports a 20% rating where flexion is greater than 30 degrees but not greater than 60 degrees.  The second PT examination (flexion 70) supports a 10% rating where flexion is greater than 60 degrees but not greater than 85 degrees.  The C&P examination (flexion 50) supports a 20% rating.  The Board consensus assigned more probative value to the second PT examination because it measured repetitive (x3) thoracolumbar spine ROM values with a goniometer versus the lumbar spine ROM values (x1) documented in the C&P examination.  There was no evidence of intervertebral disc syndrome (IVDS) which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula (for IVDS).  There was no associated radiculopathy for separate peripheral nerve rating.  While the CI may have experienced radiating pain from the back condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  There was no objective evidence of a radiculopathy with functional impairment (such as weakness) that directly impacted fitness for duty.  The Board therefore concluded that an 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 consensus concluded that there was insufficient cause to recommend a change in the PEB adjudication for the lumbar spine condition.

Contended PEB Conditions:  Adjustment Disorder and Bronchitis.  In accordance with DoDI 1332.38, E4.13.1.4 and E5, adjustment disorder is a condition that does not constitute a physical disability, and is therefore not compensable.  Regarding the bronchitis condition, the Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The bronchitis condition was not profiled or implicated in the commander’s statement and was not judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, and 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 contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the lumbar spine condition, and IAW VASRD §4.71a, the Board majority recommends no change in the PEB adjudication.  In the matter of the contended adjustment disorder and bronchitis conditions, the Board unanimously recommends no change from the PEB determinations.  The single voter for dissent recommended a disability rating of 20% and did not elect to submit a minority opinion.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140812, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 (PD201403897)

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