RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01037
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081005

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Infantryman, medically separated for “degenerative disc disease [DDD] of the 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 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 - 20080617	VARD – 20081112	
Condition	Code	Rating	Condition	Code	Rating	Exam	
DDD of the Lumbar Spine	5299-5242	10%	DDD T11-12, L1-2 and Arthropathy L4-5 and L5-S1	5242	0%	20080923	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

DDD of the Lumbar Spine.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s DDD of the lumbar spine condition began in October 2006 after a road march during basic training.  It was further exacerbated after his last jump at Airborne School in 2007.  Radiographic studies showed DDD with protruding disc material at L5-S1 resulting in contact with the L5 nerve root as well as moderate to severe arthropathy of L4-5 and L5-S1 levels.

There was no surgical indication, and conservative treatment including physical therapy (PT), medication (nonsteroidal anti-inflammatory drugs (NSAIDs), a muscle relaxer, gabapentin (for nerve pain), an epidural steroid injection, and hydrocodone with acetaminophen (a narcotic and pain reliever), and TENS (transcutaneous electrical nerve stimulation) treatments, did not result in improvement sufficient to allow unrestricted duty.   In May 2008, the CI denied radicular symptoms or sphincter problems.  The MEB forwarded chronic lower back pain secondary to multilevel DDD for PEB adjudication.

The range of motion (ROM) examinations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.  

Thoracolumbar ROM
(Degrees)	PT ~6 Mos. Pre-Sep
	MEB ~5 Mos. Pre-Sep
	VA ~12 Days Pre-Sep
	
Flexion (90 Normal)	84 (85)		88 (90)	
Extension (30)	20		34 (30)	
R Lat Flex (30)	29 (30)		36 (30)	
L Lat Flex (30)	33 (30)		36 (30)	
R Rotation (30)	44 (30)		35 (30)	
L Rotation (30)	48 (30)		35 (30)	
Combined (240)	225		240	
Comments	Goniometer; flare-ups; painful motion	No ROMs during exam; mild TTP right paraspinous muscles and moderate TTP left paraspinous muscles	Discomfort with extension; normal gait	
§4.71a Rating	10% (PEB 10%)	-	10% (VA 0%)	

At the time of the PT clinic appointment on 7 April 2008, 6 months prior to separation, the CI reported periodic numbness and tingling in both legs when bending over or when in different sitting positions.  He also reported having flare-ups of pain with a severity of 9/10 (10 being the worst pain), which lasted 5-10 minutes.  There was no reported fatigue, weakness, lack of endurance, instability or incoordination.  The CI’s gait was normal.  ROM measurements were 84 degrees of flexion (normal 90), 20 degrees extension (normal 30), 33 degrees left lateral flexion (normal 30), 29 degrees right lateral flexion (normal 30), 48 degrees left rotation (normal 30) and 44 degrees right rotation (normal 30).  There was no change of motion after three repetitions.  

The MEB NARSUM examination on 14 May 2008, 5 months prior to separation, noted complaints of constant pain 4-5/10 with shooting pains down the left leg to the mid-calf level, which was  worse with running, sit-ups, wearing body armor, lifting heavy objects, and prolonged standing.  Physical examination showed a normal gait and reflexes of the lower extremities.  There was mild tenderness to palpation of the right paraspinous muscles and moderate tenderness to palpation of the left paraspinous muscles.   

At the 23 September 2008 VA Compensation and Pension (C&P) evaluation, performed 12 days before separation, the CI reported back pain of 3/10.  He also reported left lower lateral leg numbness after sitting greater than 10-15 minutes.  As soon as he moved his leg, the numbness would dissipate.  His back was aggravated with standing greater than 30 minutes, lifting or moving objects, and sitting for a prolonged period.  He had a back brace but did not wear it and reported neither being hospitalized nor incapacitated.  Physical examination showed a normal gait and no tenderness to percussion or palpation of the paraspinal muscles.   ROM measurements were 88 degrees of flexion and 34 degrees extension with complaints of discomfort in the low back, 36 degrees left lateral flexion, 36 degrees right lateral flexion, 35 degrees left rotation, and 35 degrees right rotation (30 normal).  The CI complained of discomfort in the low back area during testing, but there was no radiation down his leg.  Multiple repetitions of motion of the CI’s back revealed no loss of motion and no further disability due to pain, weakness, fatigue or lack of endurance. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the DDD of the lumbar spine condition 10%, coded analogously to 5242 (degenerative arthritis of the spine), citing limitation of motion.  The VA rated the DDD of the lumbar spine condition 0%, and also coded 5242 (degenerative arthritis of the spine), based on the VA C&P examination 12 days before separation, citing limitation of forward flexion and combined ROM.  The Board agreed that a 10% rating, but no higher, was justified for the limitation of flexion (greater than 60 degrees but not greater than 85 degrees) reported on the PT examination 6 months before 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.  There was no documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes which would provide for a higher rating under the formula for that condition.  The Board also considered whether an additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  Radiographic studies supported some level of radicular nerve irritation or involvement, but physical examinations (physical medicine, PT, MEB NARSUM, and VA C&P) 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 the 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).”  A 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.  Therefore, the Board 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 DDD of the lumbar spine condition.  

BOARD FINDINGS:  In the matter of the DDD 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 20150603, 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 MAR 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170001096 (PD201501037)

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