RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04125
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040303

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, medically separated by the Informal Physical Evaluation Board (PEB) for “L5-S1 degenerative disk disease, without neurologic abnormality,” with a combined disability rating of 10%.

CI CONTENTION:  The CI requests consideration of all conditions.  The CI’s complete submission is in 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 - 20040204	VARD - 20040512	
Condition	Code	Rating	Condition	Code	Rating	Exam	
L5-S1 Degenerative Disk Disease without Neurologic Abnormality	5242	10%	Degenerative Disc Disease…Lumbar Spine, L5-S1	5237	10%	20040227	
			Radiculopathy, Left Leg	8599-8520	0%	20040227	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

L5-S1 Degenerative Disk Disease without Neurologic Abnormality.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in 1999 after falling approximately 15 feet from a helicopter.  Magnetic resonance imaging (MRI) studies dated 15 July 2003 showed degenerative disc disease (DDD) at L5-S1 with a disc extrusion with mild mass effect on the left S1 nerve root.  Evaluation by orthopedics on 5 August 2003 revealed a positive straight leg raise (SLR) test (assesses for herniated disc causing sciatic nerve root [L5-S1] radiculopathy) on the left.  Strength was normal, except for 4+/5 plantar flexion on the left.  Deep tendon reflexes (DTRs) were normal, except for no Achilles reflex on the left, and pathologic reflexes were absent.  The assessment listed “L5-S1 left-side herniated nucleus pulposis with degenerative disc.”  A left sided L5-S1 microdiscectomy was recommended.  The MEB NARSUM examination on 14 November 2003, 4 months prior to separation, noted a history of DDD with complaints of low back and left leg pain.  Pain was aggravated by prolonged standing and prolonged walking.  Pain was rated as constant and moderate.  Goniometer measured lumbar spine range of motion (ROM) was flexion of 20 (90 normal), extension of 10 (30), and bilateral lateral flexion of 10 (30) degrees.  He had no motor or sensory deficit in either lower extremity, and a positive SLR on the left.  He was unable to perform his duties without restriction and took Vicodin (narcotic) and Flexeril (muscle relaxer) for pain relief.  Surgery was never performed.  Physical therapy (PT) measured ROM for the MEB on January 2004, 2 months before separation, showed repetitive (X3) ROM was flexion of 85/85/90 (90) and extension of 25/35/35 (30) degrees.  

The 27 February 2004, VA Compensation and Pension (C&P) examination was not in evidence; however, the VARD documented findings from C&P examination in the rating decision.  The lumbar spine examination revealed symmetry, midline vertebrae, normal contour, well-developed muscle tone, good strength, and no tenderness.  Lumbar spine ROM was flexion of 70 (90), extension of 30 (30), bilateral lateral flexion of 30 (30), bilateral rotation of 45 (30), and total of 220 (240) degrees.  Discomfort was noted on flexion to 70 degrees. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5237 code (lumbosacral strain), citing L5-S1 DDD, without neurologic abnormality, with 3/5 Waddell's signs, and thoracolumbar forward flexion of 85 degree.  The VA assigned a 10% rating under the 5237 code (lumbosacral strain) based on the VA C&P examination 1 month before separation, citing discomfort on extreme of flexion and limitation of motion.  The Board agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) reported at the PT and VA C&P examinations proximate to separation.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  Radiographic studies supported some level of radicular nerve irritation or involvement, but physical examinations (PT, MEB NARSUM, and VA C&P) proximate to separation revealed no objective findings of radiculopathy that would impact duty performance.  The presence of functional impairment with a direct impact on fitness is the key determinant in the Board’s decision to recommend any condition for rating as additionally unfitting.  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).”  Therefore the critical decision is whether or not there was a significant motor weakness which would impact military occupation-specific activities.  There was no evidence in this case that motor weakness existed to any degree that could be described as functionally impairing.  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 concluded that there was insufficient cause to recommend a change in the PEB adjudication for the back condition.  

BOARD FINDINGS:  In the matter of the L5-S1 degenerative disk disease 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 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 AR20160013825 (PD201404125)

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