RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04038
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080814

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

CI CONTENTION:  The CI requests the Board 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 - 20080609	VARD - 20090623	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar Degenerative Disc Disease	5299-5242	10%	Lumbar Degenerative Disc Disease and Herniated Nucleus Pulposus L5-S1 Status Post Discectomy	5242	20%	20090206	
			Left L5 Radiculopathy	8599-8520	10%	20090206	
Asthma	Not Unfitting 	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Lumbar Degenerative Disc Disease.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent back surgery with discectomy and hemi-laminectomy in November 2007 for herniated disc with left lower extremity radiculopathy.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic low back pain, secondary to degenerative disc noted at L5-S1, status post diskectomy November 2007” for PEB adjudication.
At the MEB examination (recorded on the DD Form 2807 Report of Medical History and the DD Form 2808 Report of Medical Examination) dated 13 March 2008, 5 months prior to separation, the CI reported that he was “dealing with sciatic nerve issue.”  Physical examination showed decreased ROM of the lumbosacral spine, but no actual measurements were reported.  Straight leg raise testing was positive on the left at 45 degrees and on the right at 50 degrees.  

The MEB NARSUM examination on 13 March 2008, 5 months prior to separation, noted complaints of chronic daily back pain that worsened “with any exertional activity, prolonged standing or sitting, going up and down stairs, twisting and turning.”  Physical examination documented forward flexion ROM to 75 degrees (90 normal), and extension to 30 degrees (normal).  ROM was limited by pain.  His motor strength, sensation, reflexes, gait and spinal contour were all normal.  There was no complaint of radiating pain on movement.  The CI reported pain with examination maneuvers not expected to elicit pain based on the known pathology.  The physical therapy (PT) ROM study on 17 March 2008, recorded ROM flexion to 75 degrees on 3 trials and normal extension on all 3 trials.  There was no evidence of painful motion.  Measurements were taken with either a goniometer and/or inclinometer.  The examiner was not specific about which measurement tool he used.  There were no other findings in this examination.  

The electro-diagnostic study dated 4 April 2008, approximately 4 months prior to separation, noted “evidence of a re-innervation of the left S1” nerve root, interpreted as “likely represents healing of a previous left S1 radiculopathy.”  At the VA neurosurgery clinic examination on 1 May 2008, 3 months prior to separation, the examiner recorded that the CI had low back pain with residual radicular symptoms.  On examination the CI was noted to have normal motor strength with decreased sensation in his left foot and decreased ankle jerk (reflex) in left low extremity. 

At the VA Compensation and Pension (C&P) examination on 7 February 2009, 6 months after separation, the CI reported that his pain was a “band across the low back right above the tailbone, and the pain radiated down the left lower extremity along the posterior aspect of the left buttocks, left thigh, left calf and the sole of the left foot.”  He also had “decreased sensation throughout the entire left lower extremity.”  The CI denied periods of flare-ups and periods of incapacitation.  Physical exam showed forward flexion to 60 degrees, and extension of 25 degrees.  There was no change in ROM after repetitive testing.  He had significant tenderness to palpation of the L4 and L5 vertebrae, but no evidence of muscle spasm.  The CI was noted to also have normal motor strength, sensation, reflexes, gait, and spinal contour. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10% coded 5299-5242 (analogous to degenerative arthritis of the spine), citing limitation of forward flexion to 75 degrees.  The VA rated the back condition 20% coded 5242, based on the VA C&P examination 6 months after separation, citing forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees.  

The Board agreed that a 10% rating was justified for limitation of flexion greater than 60 degrees but not greater than 85 degrees reported on the NARSUM and PT exams 5 months before separation.  There was no evidence of intervertebral disc syndrome resulting in incapacitating episodes requiring bed rest prescribed by a physician to warrant consideration of rating under the alternate VASRD formula based on incapacitating episodes due to intervertebral disc syndrome.  The Board also considered if an additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI had a herniated disc with radicular pain treated with surgery, and there were symptoms of radiating pain documented in the treatment records; however, examinations indicated normal strength, reflexes, sensation and gait.  While the CI may have suffered additional pain from the nerve involvement, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  The Board therefore concluded that 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 concluded that there was insufficient cause to recommend a change in the PEB adjudication for the back condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that asthma was not unfitting.  Although this condition was profiled, it was not implicated in the commander’s statement and was not judged to fail retention standards according to the MEB which characterized it as “medically acceptable.”  At the community care clinic visit on 2 January 2008, 7 months prior to separation, the CI reported “pulmonary symptoms of asthma since childhood” and that he “was on prednisone as a child.”  The pulmonary disease clinic visit on 14 March 2008, 5 months prior to separation, indicated that the CI had a history of asthma as a child and adolescent with minimal symptoms, his symptoms increased after deployment, but at the time of the exam were well controlled.  His use of albuterol was “rare” and his lung examination was normal.  His pulmonary function test showed a mild obstructive defect with positive bronchodilator response.  The asthma condition was reviewed and considered by the Board.  There was no performance based evidence from the record that this condition significantly interfered with satisfactory duty performance.  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 of the contended asthma condition and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the back condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended asthma condition, the Board unanimously agrees that it cannot recommend it for additional disability rating. 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, with attachments
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 AR20160011794 (PD-2014-04038)

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