RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00232
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20091223

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Cavalry Scout, medically separated for “lumbar intervertebral disc syndrome,” with a disability rating of 10%.

CI CONTENTION:  “The VA found more stuff wrong with me.”  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 FPEB - 20090908	VARD - 20100924	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar Intervertebral Disc Syndrome	5243	10%	Degenerative Disc Disease of the Lumbar Spine and Lumbar Strain	5243	20%	20100324	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Lumbar Intervertebral Disc Syndrome.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in March 2007.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “LBP [low back pain], DDD [degenerative disc disease],” for PEB adjudication.  The MEB NARSUM examination on 4 February 2009 (11 months prior to separation) noted complaints of achy and sharp mid-low back pain which prevented running, performing sit-ups or carrying his equipment.  The back condition reportedly began “spontaneously.”  He used narcotic medication for pain.  Physical examination showed the CI to be “unusually fit-appearing” and “in no acute distress who walks, sits, and stands well.”  The examiner also indicated the CI was symptomatically experiencing a “good day.”  There was no tenderness or muscle spasm, and lumbar lordosis was normal.  Thoracolumbar flexion was 80 degrees (normal 90) and combined range of motion (ROM) was 215 degrees (normal 240).  A sign of possible nerve root irritation was positive on each side, but lower extremity neurologic findings were normal.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated 20 February 2009, the CI reported he had lost feeling in his legs due to his back condition.  Physical examination showed “limited” back ROM, and guarding during extension.

A clinical memorandum on 2 June 2009 indicated the CI was experiencing left lower extremity radicular symptoms, and he was given a cane in an effort to help with comfort.  At the time of a neurologic evaluation on 15 June 2009, 6 months prior to separation, the CI reported a 6 week history of left lower extremity weakness, numbness and tingling that began after working on his hands and knees.  On examination, the CI had an antalgic gait with use of a cane.  Neurologic findings were normal except for some unusual, inconsistent sensory abnormalities.  A subsequent MRI showed moderate disc protrusion at L5-S1 with no distortion or flattening of the exiting nerve root, and was unchanged compared to a study in 2008.  Electrodiagnostic studies on 24 June 2009 did not show any evidence of neuropathy or radiculopathy, and reassurance was provided to the CI there was no evident neurologic cause for the left lower extremity symptoms.

At the 24 March 2010 VA Compensation and Pension (C&P) evaluation, performed 3 months after separation, the CI reported constant, severe pain that did not radiate.  He reported that the back condition was caused when his vehicle was hit by an IED and “he was thrown back into his hatch.”  He endorsed use of a brace and a cane, and also indicated he could walk for 1-3 miles.  He denied lower extremity numbness, tingling or weakness.  Incapacitating episodes were also denied.  Physical examination showed painful motion and tenderness of the spine; however, spinal curves were normal, and there was no guarding and no spasm.  Although gait was reported as abnormal (“poor propulsion”) it was not considered by the examiner to be due to spasm or guarding.  Thoracolumbar flexion was 60 degrees and combined ROM was 205 degrees.  Painful motion occurred at 60 degrees of forward flexion, and painful motion was present in all other parameters of motion.  Lower extremity muscle strength was normal and a test for nerve root irritation was negative.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5243 (intervertebral disc syndrome), citing the VASRD General Rating Formula for Diseases and Injuries of the Spine.  The VA rated the back condition 20% under the same code based on the VA C&P examination 3 months after separation, citing limited forward flexion of the thoracolumbar spine.  The Board agreed the respective ratings by the PEB and the VA were appropriate based on the available ROM data (i.e. 10% for flexion greater than 60 degrees but not greater than 85 degrees; and 20% for flexion greater than 30% but not greater than 60 degrees).  The Board majority assigned preponderant probative value to the VA C&P evaluation, which reflected measured ROM that was the most proximal to the time of separation.  This exam justified a 20% rating, but no higher, for limitation of flexion (greater than 30 degrees but not greater than 60 degrees).  There was no documentation of incapacitating episodes which would provide for a higher rating.  Finally, although the CI experienced radiating pain, there was no objective evidence of a radiculopathy or functional impairment with a direct impact on fitness.  Radiating pain from the back condition 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 noted the electrodiagnostic test on 24 June 2009, which showed no evidence of neuropathy or radiculopathy, was consistent with the lack of physical examination evidence suggestive of neurologic disability (form example, motor weakness).  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 recommends a disability rating of 20% for the lumbar intervertebral disc syndrome condition, coded 5243.  

Contended PEB Conditions:  Severe, Incapacitating Headaches and Right Knee Meniscal Tear.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  Neither of the conditions were profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that either of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for either of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the lumbar intervertebral disc syndrome condition, the Board majority recommends a disability rating of 20%, coded 5343 IAW VASRD §4.71a.  The single voter for dissent recommended no change and did not elect to submit a minority opinion.  In the matter of the contended severe, incapacitating headaches and right knee meniscal tear conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Lumbar Intervertebral Disc Syndrome	5243	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150324, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB										

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

03 MAR 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170002573 (PD201500232)

1.  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, accept the Board’s recommendation to modify the individual’s disability rating to 20% without re-characterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA