RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01038
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060324

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Air National Guard or National Guard E4, Infantryman, medically separated for “chronic low back pain (LBP) secondary to degenerative disc disease (DDD)” with a disability rating of 10%.  

CI CONTENTION:  “Review all conditions.”  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20060214	VARD - 20061108	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP Secondary to DDD	5299-5242	10%	Compression Fracture, T7 with Back Strain	5235	10%	20060224	
Bilateral Hearing Loss	Not Unfitting	Bilateral Hearing Loss	6100	0%		
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic LBP Secondary to DDD.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s LBP condition began in July 2005 after a motor vehicle crash while on patrol.  There was no surgical indication and the CI’s condition could not be rehabilitated to allow for unrestricted activity and completions of all tasks required of his military specialty.  The MEB forwarded “chronic back pain, thoracic and lumbar” for PEB adjudication.  

Radiographic (X-ray) lumbar spine study done in November 2005 showed mild degenerative change at L5-S1.  A radiographic (X-ray) thoracic spine study done in December 2005 was normal.  Diagnostic imaging (magnetic resonance imaging [MRI]) of the thoracic spine done in November 2005 showed an approximate 25% old anterior compression fracture of a T6 vertebral body with no compression of the spinal cord identified.  The lumbar spine MRI done in November 2005 showed minimal broad based bulging discs at L4-5 and L5-S1 with no impingement on the central canal or peripheral nerves exiting the neuroforamen.  

The 15 December 2005 MEB NARSUM examination, 3 months prior to separation, noted complaints of daily constant pain in his upper and lower back that averaged 5/10 and was aggravated by carrying heavy loads, prolonged sitting and standing.  The physical examination findings are summarized in the chart below.  Electrodiagnostic studies (EMG/NCV)] performed on 20 January 2006, 2 months prior to separation, showed a denervation in the left gastrocnemius muscle and left S1 paraspinal which indicated a mild left S1 radiculopathy.  

At the 24 February 2006 VA Compensation and Pension (C&P) evaluation, a month before separation, the CI reported daily constant pain in his upper and lower back rated at 7-8/10.  He reported 120 days of incapacitation; however, there was no medical documentation in the treatment record of this.  The physical examination findings are summarized in the chart below.  

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

Thoracolumbar ROM
(Degrees)	MEB NARSUM~3 Mos. Pre-Sep	MEB H&P 3 Mos. Pre-Sep	PT~3 Mos. Pre-Sep	VA 29 Days Pre-Sep	
Flexion (90 Normal)	90 (116)	Full	90 (116)	75	
Combined (240)	240	240	240	175	
Comments	Motor normal (nl); gait nl; mild tender mid back, along left side T-spine	Painful motion, straight leg raise (SLR) negative bilaterally	Inclinometer;  gait nl	Gait nl; painful motion; tender; + bilateral SLR; Deluca + pain, weakness, fatigue, weakness, lack of endurance; motor, sensory, reflexes nl	
§4.71a Rating	10%	10%	0%	10%	

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic LBP secondary to DDD condition 10%, analogously coded 5299-5242 (Degenerative arthritis of the spine), citing ROM of 240 degrees.  The VA rated the Compression Fracture, T7 with Back Strain condition 10% coded 5235 (Vertebral fracture or dislocation), based on the VA C&P examination  a month before separation, citing vertebral body fracture with loss of 50% or more of the height.  

There was no limitation of thoracolumbar spine motion to support a minimum rating under the General Rating Formula for Diseases and Injuries of the Spine; however, the MEB examination and VA C&P evaluation noted the presence of painful motion as well as the MEB NARSUM examination documenting tenderness.  IAW with VASRD §4.59, painful motion, a minimum compensable evaluation of 10% was therefore warranted in accordance with the General Rating Formula For Diseases And Injuries Of The Spine coded 5235; however, this provided no rating advantage to the CI.  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 panel also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  Radiographic and electrodiagnostic studies supported some level of radicular nerve irritation or involvement, but physical examinations 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 panel’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).”  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 panel 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 Panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the chronic LBP secondary to DDD condition.  

Contended PEB Condition:  Bilateral Hearing Loss.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the chronic LBP secondary to DDD condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended bilateral hearing loss condition, the panel unanimously recommends no change from the PEB determination as not unfitting.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150608, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170008424  , XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					      
						      					
Enclosure