RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00843
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081004

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve O2, Medical-Surgical Nurse, medically separated for “degenerative arthritis, lumbar spine” with a disability rating of 10%.  

CI CONTENTION:  “Review all conditions.”  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 - 20080821	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Arthritis, Lumbar Spine	5242	10%	No VA Examination in Evidence 	
RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Degenerative Arthritis, Lumbar Spine.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s degenerative arthritis, lumbar spine condition began in 2005 while on active training.  She re-aggravated her back in January 2006 after slipping while stepping into the shower and hearing a pop in her back. Diagnostic imaging (MRI) studies 9 January 2006 showed degenerative disc disease at L5-S1 with right sided disc herniation and impingement of the right S1 nerve root.  The examiner noted the disc herniation had worsened significantly from a previous study.  Lumbar discectomy surgery was performed in February 2006.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic low back pain due to herniated nucleus pulposus at L5/S1, status post discectomy” for PEB adjudication.  
The MEB NARSUM examination on 17 July 2008, 2 months prior to separation, the CI reported constant low back pain (LBP), with intermittent paresthesia (sensory disturbances) of the right leg.  The LBP was aggravated by sitting and standing for extended periods and prevented her from performing her military duties.  The physical examination showed normal gait, sensation, and reflexes.  There was tenderness to palpation of the L5 region.  Straight leg raise testing was negative for radiating symptoms.  Thoracolumbar range of motion measurements were flexion 90 degrees, extension 20 degrees, and normal right lateral and left lateral flexion (30 degrees) with painful motion noted.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the degenerative arthritis, lumbar spine condition 10%, coded 5242 (degenerative arthritis of the spine), citing tenderness and spasm of the lower back.  The CI did not file a VA claim.  Although there was insufficient limitation of motion to support a minimum rating, the Board agreed a 10% rating was justified for the presence of painful motion, tenderness, and spasm.  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.  Although the CI did have intervertebral disc syndrome (IVDS), there was no evidence of incapacitating episodes requiring physician-prescribed bed rest 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 degenerative arthritis, lumbar spine condition.  

The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  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.  The CI did experience a disc herniation with compression of the right S1 nerve root and reported intermittent paresthesia of the right leg at the MEB NARSUM examination.  However, lower extremity strength, sensation and reflexes were normal.  Radiating pain is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates)” and there was no evidence of a radiculopathy with functional impairment (such as weakness) that directly impacted fitness for duty after the surgery.  The Board therefore concluded that an additional disability rating was not justified on this basis.  

BOARD FINDINGS:  In the matter of the degenerative arthritis, 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 20150604, 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 
XXXXXXXXXXXXXXXXXX, AR20170000806 (PD201500843)

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