RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00486
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080327

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4 (Tracked Vehicle Mechanic) medically separated for “lumbar degenerative disc disease,” with a disability rating of 10%.

CI CONTENTION:  “Condition has worsened over the years.”  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 on 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 - 20080326	VARD - 20080204	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar Degenerative Disc Disease	5299-5242	10%	Degenerative Disc Disease Thoracic/Lumbosacral Spine	5243-5243	0%	20080204	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Lumbar Degenerative Disc Disease.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s lumbar degenerative disc disease (DDD) condition was identified in August 2004.  The CI’s condition was chronic and managed conservatively.  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 an MEB.  The MEB forwarded “low back pain secondary to herniated nucleus propulsus” for PEB adjudication.

Magnetic resonance imaging performed in October 2006 revealed multi-level bulging disc of the lumbosacral spine.  At a physical therapy (PT) examination on 24 April 2007 (11 months prior to separation), the CI stated he was “doing fine” but still having back pain.  He additionally endorsed muscle spasms about 2 times a day, usually when walking.  He denied any radicular component to his pain.  His physical examination (PE) revealed a normal gait with slight tenderness about the lumbosacral spine.  His neurologic examination was normal.  Active thoracolumbar range of motion (ROM) revealed that the CI could forward flex with hands to distal tibias (interpreted as 90 degrees or full forward flexion).  All other planes of ROM were normal with painful motion upon extension and rotation.  At the MEB NARSUM examination on 30 November 2007 (4 months prior to separation), the CI remained with complaints of low back pain with baseline 4-5/10 in intensity which prevented him from running, wearing IBA or Kevlar, jumping, marching or repetitive bending.  His PE revealed tenderness over lumbar vertebrae as well as over lumbar muscles adjacent to the spine.  His neurologic examination remained normal.  Thoracolumbar ROM as measured with an inclinometer revealed painful and decreased extension at 20 degrees (normal = 30) and bilateral lateral flexion of 20 degrees (normal = 30).  Forward flexion and bilateral rotation were normal.  

At the VA General Medical Compensation and Pension (C&P) evaluation on 2 February 2008 (2 months prior to separation), the CI reported constant pain described as a “dull ache” with increased pain brought on by prolonged standing.  Additionally, he endorsed pain occasionally radiated from the lower back into the right lower extremity.  The CI effectively treated his low back pain with rest, activity modification and medication.  His PE revealed a normal gait, posture and balance.  There was no tenderness along the vertebra or loss of normal spinal curve.  ROM measurements were normal excepting a 10 degrees loss in extension measured at 20 degrees (normal = 30).  The examiner noted “mild discomfort” when describing the CI’s spinal motion.  Neurologic examination revealed no evidence of sensory or motor impairment.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition at 10%, analogously coded 5299-5242 (degenerative arthritis of the spine), citing no neurologic deficit, tenderness without spasm or guarding, and ROM limited by pain.  The VA rated the low back condition at 0% coded as 5243-5243… (Board members considered the VA’s coding as a clerical error in repeating the same code indicating intervertebral disc syndrome) based on the C&P examination 2 months before separation, citing forward flexion of the thoracolumbar spine of greater than 85 degrees; or combined ROM of the thoracolumbar spine greater than 235 degrees.

The Board agreed that a 10% rating, but no higher, was justified for the persistence of painful motion as seen in pre-separation examinations.  There was no objective finding significant limited motion, muscle spasms, 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 to warrant consideration of rating under the alternate VASRD formula (for IVDS).  The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  Although radiographic studies supported some level of radicular nerve irritation or involvement, the PE’s 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 a 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 lumbar DDD of the low back.  

BOARD FINDINGS:  In the matter of the lumbar DDD 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 20150530, 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, AR20170000265 (PD201500486)

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