RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00592
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081114

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E5, Motor Transport Operator, medically separated for “lumbar degenerative disc disease,” with a disability rating of 10%.  

CI CONTENTION:  The CI contends that he was medically discharged for his back condition but never had the opportunity to get a rating.  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 - 20080923	VARD -  No Claim	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar Degenerative Disc Disease	5299-5242	10%	--	--	--	--	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Lumbar Degenerative Disc Disease.  According to service treatment records (STRs) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began with a strain injury in September 2005.  He reinjured his back during pre-deployment training in July 2006.  There was persistent back pain associated with right lower extremity (RLE) radiation and intermittent sensory symptoms.  Imaging (CT) demonstrated disc disease (diffuse degenerative changes, bulge at L4/5, bilateral neural encroachment L4-S1).  Electrodiagnostic testing (EMG) did not demonstrate a spinal neuropathy (equivocal left sural nerve findings).  There were multiple normal neurological examinations recorded in STR clinical entries, with none to the contrary.  There were no entries indicating any significant range of motion (ROM) limitation.  The most detailed evidence from the outpatient STR was from a neurosurgical consultant in August 2007 (15 months before separation).  This noted RLE radiation and sensory complaints without subjective weakness.  The physical examination recorded “a mild limp to the right” but “normal heel-toe and tandem walking.”  Spinal contour was normal with “no significant lumbar spasm,” although there was “severe” right hip and sacroiliac tenderness.  The ROM findings were flexion to 90 degrees (normal), extension to 10 degrees (normal 30), painful left rotation, and normal right rotation.  The neurosurgeon documented a detailed and normal bilateral lower extremity neurological examination, with 5/5 strength in all groups (sensory intact, reflexes symmetric). The above imaging and EMG studies were ordered.  There was no other STR evidence of gait disturbance, none for abnormal contour, and no documentation of incapacitating episodes.  Surgery was not recommended; conservative treatment did not result in sufficient improvement to allow unrestricted duty; and, the CI was referred for a MEB.  The MEB forwarded “chronic uncomplicated low back pain” to the PEB.  

The NARSUM examination in May 2008, 6 months before separation, documented “chronic daily pain that worsens with any exertional activity, prolonged standing, or sitting.”  There was no NARSUM documentation of concurrent radicular symptoms, and the physical examination recorded “no complaint of radiating pain.”  The remaining physical findings were normal gait, normal spinal contour, the absence of tenderness or spasm, and normal neurological findings (5/5 strength, no atrophy, sensory intact, reflexes symmetric).  Measured ROM was average flexion to 90 degrees with a combined ROM of 225 degrees (240 normal), specifying painful motion but no degradation with repetition.  

There was no VA claim, examination, or rating decision in this case, and no other post-separation evidence.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated 10% under code 5299-5242 (analogous to degenerative arthritis of the spine), specifically referencing and consistent with criteria of the VASRD.  There was no ROM evidence supporting a rating higher than 10%, insufficient evidence for abnormal gait or contour to support a 20% rating, and no documentation of incapacitating episodes or diagnosis of intervertebral disc syndrome that would provide for a higher rating under that formula.  The Board considered whether additional Service rating could be recommended for the associated RLE radiculopathy (possibly resolved at the time of the NARSUM); but, members agreed that neither the requisite functional link to fitness nor the presence of a VASRD ratable deficit were supported by the evidence.  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 of the lumbar spine condition.  

BOARD FINDINGS:  In the matter of the lumbar spine 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, AR20170000272 (PD201500592)

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