RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00437
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081214

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Wheeled Vehicle Mechanic, medically separated for low back pain, with a disability rating of 20%.

CI CONTENTION:  The CI was not rated for lower back, depression and PTSD.  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 - 20080828	VARD - 20150723	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar Back Pain due to Degenerative Disk Disease at L4-5 with radiating pain	5242	20%	Intervertebral Disc Syndrome to include Degenerative Disk Disease and Lumbar Strain 	5243	20%	20150520	
			Radiculopathy Right Lower Extremity, Sciatic Nerve Associated with Intervertebral Disc Syndrome to Include Degenerative Disc Disease and Lumbar Strained 	8520	40%	20150520	
			Radiculopathy Right Lower Extremity, Femoral Nerve Associated with Intervertebral Disc Syndrome to Include Degenerative Disc Disease and Lumbar Strained 	8526	30%	20150520	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS:  90%	

ANALYSIS SUMMARY:  

Low Back Degenerative Disc Disease (DDD) with Radiating Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back condition began in August 2006 after jumping off a wall in basic training.  Lumbosacral spine diagnostic imaging (MRI) on 16 July 2007 showed minimal disc disease, an L4-5 disc punctate annulus (disc fibrous exterior) tear with minimal protrusion, L4-5 facet joint arthropathy (joint disease), and patent (open or unobstructed) spinal canal and neural foramina (nerve root openings).  In October 2007, the CI underwent three serial epidural steroid injections (steroid injection into epidural space to reduce inflammation and pain).  On 1 November 2007, physical therapy (PT) measured thoracolumbar spine range of motion (ROM) with a goniometer for the MEB.  The physical examination documented an abnormal gait due to muscle spasm or guarding.  The back examination revealed localized tenderness and muscle spasm or guarding, but no abnormal spinal contour.  Pain limited repetitive (X3) ROM was flexion of 60/65/65 (90 normal), extension of 10/5/5 (30), right lateral flexion of 20/20/25 (30), left lateral flexion of 15/20/20 (30), right rotation of 30/35/35 (30), left rotation of 30/30/30 (30), and combined of 175 (240) degrees.  In December 2007, the CI underwent two left L3 and L4 median branch blocks and L5 dorsal rami blocks (block nerves to facet joints) with local anesthetic.  A 7 February 2008 electrodiagnostic (EDX) study (electromyogram [EMG] - muscle electrical activity/nerve conduction velocity [NCV] - impulse velocity) was normal.  Motor and sensory nerve NCV was normal.  Electromyography showed no evidence of lower extremity muscles denervation suggestive of nerve root compression.  There was no surgical indication.  Despite treatment, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  The MEB forwarded, “lumbar back pain due to degenerative disc disease at L4-5” and “radicular lumbar back pain” for PEB adjudication.  The 13 December 2007 NARSUM, 12 months before separation, recounted the history and interventions.  The CI complained of lumbar region pain with radicular (nerve root irritation or injury) symptoms in the left lower extremity.  He reported limited ability to bend forward and being unable to bend backwards.  Pain was exacerbated by twisting his torso, prolonged walking (>½ mile), running, jumping, rucking, marching, and lifting (>20 lbs.) and interfered with sleep.  The NARSUM documented “PHYSICAL EXAM:  The physical examination was performed on October 22, 2007 and is incorporated in this report in its entirety without change or amendment.”  The author cited the PT ROM for MEB measurements.  At the 20 May 2015 VA Compensation and Pension (C&P) examination, 5 years after separation, the CI reported low back pain, decreased motion, decreased mobility, difficulty with sitting, standing, driving, bending, twisting, and lifting, and carrying.  The back examination revealed localized tenderness and muscle spasm that resulted in abnormal gait or abnormal spinal contour as well as pain that caused functional loss.  Pain limited ROM was flexion of 35 (90), extension of 0 (30), right lateral flexion of 10 (30), left lateral flexion of 5 (30), bilateral rotation of 5 (30), and combined of 60 (240) degrees.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 20%, coded 5242 (degenerative arthritis of the spine), citing forward flexion of 60 degrees; and, IAW VASRD 4.10, 4.40, 4.45 and 4.59, the rating includes consideration of functional loss due to factors such as pain, including pain on repeated use and painful motion, fatigability, incoordination, weakness with repetitive use and flare-ups.  The VA also rated the back condition 20% coded 5243 (intervertebral disc syndrome), based on the VA C&P examination 65 months after separation, citing combined range of motion of the thoracolumbar spine not greater than 120 degrees, forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees, guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis.  Recognizing the remote temporal relationship to the date of separation, the board assigned little probative value to the VA C&P examination.  The Board agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees) or muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, reported on the PT ROM for MEB examination.  The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI reported radiation of pain to the left leg; however the EDX was normal.  There was no evidence of lumbar nerve root involvement by MRI, EDX, or physical exam.  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 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.  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 20150602, 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

08 Feb 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, XXXXXXXXXXXXXXXXXX, AR20170000102 (PD201500437)

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