RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04019
BRANCH OF SERVICE: Army                                                          SEPARATION DATE:  20090427

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3, Logistical Specialist, medically separated for a back condition.  The back could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards. She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  “Lumbar arthritis” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The Informal PEB adjudicated “degenerative arthritis of the lumbar spine” as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions.”  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2).  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 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: 

IPEB – Dated 20090224	VA* - (~2 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Arthritis of the Lumbar Spine	5242	10%	Congenital Transitional Vertebra at Lumbosacral
Junction With Partial Lumbarization and Rudimentary
Disc At Sl-S2	5242	NSC	20090630	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 4	
RATING:  10%	COMBINED RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20091111 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Lumbar Spine Condition.  The narrative summary (NARSUM) notes the CI had a history of a stress fracture of the left pelvic bone (pubic ramus) in October 2007.  At an orthopedic visit 4 January 2008, the CI reported the left hip pain was significantly decreased following convalescent leave.  Hip X-rays noted resolution of the fracture and gradual return to activity was recommended and the CI was also referred for physical therapy (PT).  After a permanent change of station move, the CI began PT and reported bilateral hip pain after resuming running for the first time in months.  A bone scan 7 October 2008 was normal.  At an orthopedic evaluation 7 November 2008, the CI reported pain in the low back and both hips that radiated to her knees.  The exam noted a normal gait.  Hip range-of-motion (ROM) was normal, without tenderness to palpation (TTP) or pain of the hips with weight-bearing.  Thoracolumbar ROM was normal and strength, sensation, and reflexes of the lower extremities (LE) were normal.  Bilateral hip and lumbar spine X-rays were normal.  Lumbar magnetic resonance imaging noted degenerative changes of the lower lumbar spine, but no central canal or neuroforaminal stenosis.  A congenital anatomic variant (transitional vertebra) was noted at the lumbosacral junction.  At the orthopedic follow-up visit the CI was given anti-inflammatory medication and a temporary profile was continued with discussion of a permanent P2 or P3 profile.  The next orthopedic visit 4 November 2009 noted that the CI was unable to complete an alternate walk test for fitness and she was unable to lift due to due to back pain.  The CI was given a P3 profile and an MEB was initiated.

At the MEB exam, the CI reported constant low back pain (LBP) aggravated by activity and improved by pain medication.  Flare-ups occurred with over-exertion, but could be avoided.  The MEB physical exam noted a normal gait.  The CI was able to walk on toes and heels.  There was TTP of the lower lumbar spine without muscle spasm or guarding and normal spinal curvatures were noted.  Strength sensation and reflexes of the LE were normal.  Physical therapy measured the thoracolumbar range-of-motion 19 February 2009 as flexion 85 degrees (normal 90) and a combined ROM of 200 degrees (normal 240), with painful motion.  

At the VA Compensation and Pension (C&P) exam 30 June 2009, performed 2 months after separation, the CI reported constant LBP.  The exam noted a normal gait.  The examiner noted there was muscle spasm, and guarding or tenderness in the lower lumbar area.  Lumbar ROM was normal, with painful motion noted.  There was no additional loss of ROM with repetition. Strength, sensation, and reflexes of the LEs were normal and straight leg raise testing was negative.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5242 (spinal arthritis).  The VA originally did not service connect the LB condition, noting the congenital transitional vertebra.  The VA Rating Decision 8 September 2011 service connected the low back condition and rated the condition 10% based on service medical records, coded 5237 (lumbosacral strain), effective the day after the date of separation.  The Board agreed that the evidence supports a 10% rating according to the VASRD General Rating Formula for the spine in effect on the date of separation for “muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour.”  The Board reviewed to see if the next higher evaluation of 20% was supported, but there was no evidence of thoracolumbar flexion of 60 degrees or less, combined thoracolumbar ROM of 120 degrees or less, or “muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour”.  The Board reviewed to see if a higher evaluation than 20% was achieved coding with 5243 (intervertebral disc syndrome) and rating based on incapacitating episodes, defined by the VASRD as bed rest prescribed by a physician and treatment by a physician.  However, there was no documentation in record of any incapacitating episodes to support rating with this approach.  There was also no evidence of neurological impairment due to the low back condition to recommend an additional rating.  The Board thus determined there was no VASRD pathway to a rating higher than 10%.  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 adjudication for the low back condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  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.  

RECOMMENDATION:  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 20140911, 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 AR20160004447 (PD201404019)

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