RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00284
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081204

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Reserve E5, Motor Transport Operator, medically separated for “chronic low back pain (LBP) status post L5-S1 discectomy without neurologic abnormality,” with a disability rating of 10%.

CI CONTENTION:  The CI contended for PTSD, neck, shoulder, hip and back.  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 - 20081015	VARD - YYYYMMDD	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP S/P L5-S1 Discectomy, without Neurologic Abnormality	5243	10%	Mild Disc Bulge, L5-S1 w/ Lumbalgia	5299-5243	10%	20091111	
			IVDS, RLE Sciatica associated w/ Mild Disc bulge L5-S1 w/ Lumbalgia	5243-8520	20%	20091111	
Adjustment Disorder	Not a Physical Disability 	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic LBP S/P L5-S1 Discectomy, without Neurologic Abnormality.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s LBP condition began initially in 1997.  She developed right lower extremity numbness and pain and underwent an L5-S1 discectomy in 2000.  She did well until 2002 when a vehicle in which she was riding struck a pothole and caused a sharp pain.  The next day she was not able to walk and presented for treatment.  Magnetic resonance Imaging (MRI) on 26 January 2004 showed degenerative disc changes at L5-S1 with impingement of the right S1 nerve root.  Despite conservative treatment with medications, physical therapy and duty restrictions, her pain persisted and she was referred for an MEB.  The MEB forwarded “chronic LBP S/P L5-S1 discectomy” for PEB adjudication.  At the MEB examination on 1 August 2008, the CI reported continued LBP and the prior surgery.  The neurological examination was checked normal.  The spine was checked abnormal, but no details were recorded.  An X-ray that day showed early degenerative changes in the lumbar spine.  MRI studies 4 days later showed post-operative changes at L5-S1 with a right laminectomy, and severe left neuro foraminal narrowing with facet degenerative changes at L5-S1.  The remaining lumbar discs were normal as were the foramina.  A neurosurgical examination on 20 August 2008, accomplished for a non-service related neck condition, noted a normal neurological examination for the lower extremities and a normal gait.  The MEB NARSUM was dated 26 August 2008, approximately 3 months prior to separation.  The CI reported occasional pain and numbness without motor weakness.  There were functional limitations which included an inability to run, jump, march, wear load bearing equipment, ruck sack or individual body armor.  The gait was normal as were the reflex and motor examinations.  Sensation was reduced in a “stocking” distribution (non-radicular).  Follow-up neurosurgical examinations on 29 August 2008 and 24 September 2008 also documented a normal evaluation of the lower extremities (no lumbar radicular findings).  The CI was seen in the emergency room on 8 October 2008 for abdominal pain.  A normal neurological evaluation was noted.  An examination in obstetrics on 1 December 2008, 3 days prior to separation from the reserves recorded a normal neurological examination.

At the 11 November 2009 VA Compensation and Pension (C&P) evaluation, performed approximately 11 months after separation, the CI reported severe constant LBP that radiated into her legs more severe on the right side.  During exacerbations, she reported pain and weakness which caused an inability to run.  She also reported back stiffness, spasms, decreased motion, paresthesias and numbness along with weakness of the leg and foot.  She denied any periods of incapacitation during the past 12 months.  The physical examination findings are summarized in the chart below.  The Board noted the marked difference in neurological findings between the VA examination and those done prior to separation from the Reserves.  The Board looked at several examinations remote from separation.  An endocrinology evaluation on 2 June 2014 and a neurosurgical evaluation on 10 June 2014 both noted an essentially normal neurological examination.  The latter noted a normal gait, an absence of atrophy, and motor function diffusely 5-/5 (slightly reduced in a non-radicular pattern).  The range of motion (ROM) examinations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.  

Thoracolumbar ROM
(Degrees)	MEB ~3 Mos. Pre-Sep	VA ~11 Mos. Post-Sep	
Flexion (90 Normal)	90	70	
Combined (240)	240	170	
Comments	Gait nml; TTP L3-S1; goniometer; motor, reflexes nml; stocking glove sensory changes Right lower extremity;	Deluca + pain; Tenderness; L4 sensory deficit; L5 motor weakness; decreased vibration, pin prick sensation; diminished ankle reflexes bilaterally;	
§4.71a Rating	10%	20%	

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the chronic LBP condition 10%, coded 5243 (intervertebral disc syndrome), citing spinal tenderness.  The VA rated the mild disc bulge, L5-S1 with lumbalgia condition 20% coded 5299 analogous to 5243, based on the VA C&P examination approximately 11 months after separation, citing forward flexion greater than 60 degrees but not greater than 85 degrees. 
A 10% rating was supported by the presence of tenderness on the NARSUM examination.  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.  There was no evidence of intervertebral disc syndrome (IVDS) which resulted in incapacitating episodes requiring physician-prescribed bed rest during the past 12 months to warrant consideration of rating under the alternate VASRD formula (for IVDS).  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 chronic LBP condition.  

The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The VA rated the intervertebral disc syndrome, right lower extremity sciatic nerve associated with mild disc bulge, L5S1, with lumbalgia condition 20%, coded 5243 with 8520 (sciatic nerve: paralysis of) citing moderate incomplete paralysis below the knee.  The MEB NARSUM examiner documented stocking glove sensory changes in the right lower extremity.  The VA C&P examiner documented L4 sensory deficit right lateral thigh, front leg medial leg; L5 sensory deficit right lateral leg, dorsal foot, lateral foot; L5 motor weakness right knee flexion 4/5, right plantar flexion 4/5, right lower extremity absent knee, ankle jerk, left lower extremity knee jerk 1+ ankle absent, decreased vibration, pin prick sensation and diminished ankle reflexes bilaterally.  However, multiple examinations proximate to separation showed a normal neurological examination as did examinations remote from separation.  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.

Contended PEB Conditions:  Adjustment Disorder.  IAW DoDI 1332.38, Enclosure 5, in effect at the time, Adjustment Disorders are “conditions which do not constitute a physical disability” and are therefore not compensable under the DoD disability evaluation system.  In addition, the condition was not profiled or cited by the commander as impairing duty.  The MEB found it to be medically acceptable for retention.  The Board concluded that the PEB adjudication for adjustment disorder was correct, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the chronic LBP condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the adjustment disorder condition, the Board unanimously recommends no change from the PEB determination. 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 20150428, 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

02 Feb 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160019823 (PD201500284)

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