RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00469
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090904

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

CI CONTENTION:  The CI made no specific contention.  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 - 20090605	VARD - 20091123	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar Intervertebral Disc Syndrome	5243	10%	Lumbar Spine:  L5-S1 Bony Canal Stenosis Spondyloarthropathy; Herniated Disc L5-S1	5238-5243	10%	20090413	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

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 October 2001 after falling.  Pain was intermittent until 2005 when the CI began having low back pain radiating down both legs.  Radiographic studies in May 2008 indicated degenerative disc disease (DDD) at L5-S1 with left paracentral disc herniation and bulge.  The recommendation was referral to pain management and conservative treatment.  At a neurological examination in June 2008 the CI reported numbness throughout the left leg and “intense pain” in the ankle.  The CI reported numbness in the bottom of his foot and base of his toes.  Physical examination showed a positive straight leg raise (SLR) at 50 degrees with pain to the knee.  Neurological examination revealed “no decreased response to tactile stimulation of the leg/foot.”  Left lower extremity (LLE) weakness was observed with no right lower extremity weakness.  Balance was normal.  Limping was noted on the left with normal heel/toe walking.  Tandem gait was normal.  Reflexes were normal.  The CI was diagnosed with left S1 radiculopathy and disc herniation at L5-S1.  Further conservative treatment was recommended.  Surgery was not recommended.  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 “chronic low back pain due to herniated disk L5-S1 with spondyloarthropathy and left lower extremity radicular symptoms,” for PEB adjudication.  

The MEB NARSUM examination on 11 May 2009, 4 months prior to separation, noted complaints of back pain that had increased in severity with radicular symptoms to the LLE.  There was no indication of bowel, bladder or erectile dysfunctions.  Physical examination showed a normal gait.  The CI was able to heel/toe walk.  Deep tendon reflexes were 2+ and equal at ankles bilaterally.  He had no neurosensory deficits.  SLR was negative bilaterally.  There was tenderness to the sacroiliac joint and palpation produced an immediate electrical sensation to the heel which also disappeared immediately.  There was no left sciatic notch tenderness.  Recorded range of motion was flexion to 80 degrees (normal 90) and combined ROM was 215 degrees (240 normal), limited by pain.  

At the 13 April 2009, VA Compensation and Pension (C&P) evaluation, performed 5 months before separation, the CI reported low back pain with numbness and shooting sensation to his left leg.  He reported 2/10 on pain scale with flare-ups 1-2 times every 6 months.  There were no additional limitations noted.  Physical exam showed tenderness to the left lower back, no muscle spasm, muscle strength 5/5 and negative provocative testing for radiculopathy (SLR).  Recorded active ROM flexion was 80 degrees (90 normal) with pain, and combined ROM of 230 degrees (240 normal).  There were no additional limitations from pain, weakness or lack of endurance after repetition.   

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the lumbar intervertebral disc syndrome condition 10%, coded 5243 (intervertebral disc syndrome), citing limitation of motion.  The VA also rated the lumbar spine condition 10% coded analogously 5238-5243, based on the VA C&P examination 4 months before separation, citing painful motion and limitation of forward flexion and combined ROM.  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) and/or combined ROM greater than 120 degrees but not greater than 235 degrees) reported on all 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 considered whether a higher rating (§4.7) was achieved by using the alternate rating formula based on incapacitating episodes due to intervertebral disc syndrome (IVDS).  Although the CI had intervertebral disc disease there were no incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula (for IVDS).  There was no associated radiculopathy for separate peripheral nerve rating.  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.  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 lumbar intervertebral disc syndrome 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 20150601, 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

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXXX, AR20170000124 (PD201500469)

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