RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01461
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050708

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty Reserve O2, Quartermaster Officer, medically separated for “lumbago, status post microlaminectomy at L4-L5 without neurologic abnormality,” with a disability rating of 10%.  

CI CONTENTION:   “Review all conditions.”  The CI’s 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 conditions 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 - 20050708	VARD - 20060419	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbago, S/P Micro Laminectomy at L4-L5 without Neurologic Abnormality	5299-5242	10%	Degenerative Disc Disease (DDD) and Degenerative Joint Disease (DJD) of Thoracolumbar Spine with Residuals of Laminectomy at L4-5 and also Radiculopathy of Left Lower Extremity(LLE)	5242	20%	20060214	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Lumbago Status Post Microlaminectomy at L4/L5.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had a history of scoliosis (abnormal lateral spine curvature), wearing brace for 2 years as a child, and associated low back pain prior to entering the Army.  The 29 September 2004 scoliosis series radiographic (X-rays) studies showed lower thoracic and lumbar spine scoliosis with convexity towards the left.  Serial thoracic and lumbar spine magnetic resonance imaging (MRI) studies showed moderate rotoscoliosis (abnormal rotational and lateral spine deviation) and a large L4-L5 disc herniation.  The CI failed conservative management (physical medicine and rehabilitation, pain management, physical therapy (PT), epidural steroid injections, non-steroidal anti-inflammatories, and narcotics) and opted for operative intervention.  On 3 January 2005 the CI underwent a left L4-L5 microlaminectomy.  The 7 March 2005 lumbar spine MRI showed postoperative changes, a generalized disc protrusion at L5-S1, and no suggestion of recurrent or residual disc herniation at L4-L5.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “lumbago status post microlaminectomy at L4/L5” for PEB adjudication.  At the time of the physical therapy appointment on 3 May 2005, for range of motion (ROM) measurements with a goniometer/inclinometer for the MEB.  Lumbar spine active ROM values were flexion of 30 degrees (normal 90) and a combine ROM of 140 degrees (normal 240).

The 9 May 2005 NARSUM, 2 months before separation, recounted the history and interventions.  The CI complained of daily low back pain.  “Her physical therapy was then modified to just stretching and she began to feel some relief when continuous walking was discontinued.  The CI stated that as long as she doesn't sit, stand or walk for any prolonged period of time the pain is manageable with medication.”  The physical examination documented a normal gait.  The back examination revealed a well healed pink keloid (abnormal/excessive scar tissue) scar, tenderness at L4-L5, and mild paraspinal tenderness at L4-L5 and L5-S1.  Strength and sensation were intact.  Neurosurgery did not recommend any surgical intervention as it related to the L5-S1 disc and indicated that with age the CI may need a future surgical procedure to either remove or supplement her discs that are degenerating.  The diagnosis listed lumbago status post microlaminectomy at L4-L5.  

The 14 February 2006 VA Compensation and Pension (C&P) examination, 7 months after separation, recounted the history and interventions.  The CI complained of constant, dull, 4-5/10 low back pain status post L4-L5 laminectomy.  “Post-surgery, she was able to walk and there is some pain relief; however, she relates she is not at the premorbid level.”  There was associated pain radiation into the lateral left lower extremity with paresthesias (abnormal sensation, tingling, burning, and prickling).  Flare-ups occurred with prolonged standing and walking, and were relieved by rest breaks and postural changes.  The CI had not missed work for this and was not taking any medication.  The physical examination documented a guarded gait, a slight right lateral shift in posture, and no assistive devices.  The back examination revealed a well healed, nontender, superficial, stable, and linear (2 ½ inch) lumbar scar.  The spine examination revealed slight paralumbar tightness with no paralumbar muscle spasms, atrophy, asymmetry, abnormal curvatures, or abnormal disc diameters.  ROM measurements showed a flexion of 45 degrees and a combined ROM of 140 degrees.  “There is additional limitation of pain with repetitive use, but no change in range of motion.”  The straight leg raise ([SLR] assess for herniated disc causing sciatic nerve root [L5-S1] radiculopathy) tests were negative.  Sensation was intact except for “sensory is diminished in L5 distribution on the left side.”  The diagnosis listed thoracolumbar spine degenerative disc and joint disease, residuals of L4-L5 laminectomy, and radiculopathy (nerve root irritation or injury) of left lower extremity.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5242 code (degenerative arthritis of the spine) citing lumbago, degenerative disc disease by MRI, status post L4-L5 microlaminectomy, tenderness to palpation, thoracolumbar ROM limited by pain, and without neurologic abnormality.  The VA assigned a 20% rating under the 5242 code (degenerative arthritis of the spine), based on the VA C&P examination 7 months after separation, citing thoracolumbar spine degenerative disc and joint disease, residuals of L4-L5 laminectomy, thoracolumbar ROM limited by pain, and left lower extremity radiculopathy.  The VA C&P examination ROM values were consistent with the 20% rating (flexion of greater than 30 degrees but not greater than 60 degrees).  The panel assigned more probative value to the VA C&P examination because it measured thoracolumbar spine ROM values versus the back and lumbar spine ROM values documented in the PT for MEB examination.  Recognizing the temporal relationships to the dates of surgery and separation, the panel assigned more probative value to the VA C&P examination after appropriate convalescence, as accurately reflecting the CI’s condition on which to base the permanent rating recommendation.  

While the CI complained of radiation of pain and paresthesias to her left lower extremity, there was no evidence that motor weakness or sensory impairment existed to any degree that could be described as functionally impairing.  The panel therefore concluded that additional disability rating was not justified on this basis.  There was no documentation of incapacitating episodes that would justify a minimum rating under the alternative formula for rating intervertebral disc disease.  While the proximate examinations documented tenderness, there was no evidence of muscle spasm, abnormal spinal contour, or abnormal gait.  Other routes to a rating higher than the PEB’s 10% were considered, but there was no evidence of additional functional loss from repetitive use to warrant application of VASRD §4.45.  The Panel agreed a 10% rating was supported based on VASRD §4.40 (functional loss) or §4.59 (painful motion).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Panel recommends a disability rating of 20% for the lumbago status post microlaminectomy at L4/L5 condition, coded 5299-5242.  

BOARD FINDINGS:  In the matter of the lumbago status post microlaminectomy at L4/L5 condition, the panel unanimously recommends a disability rating of 20%, coded 5299-5242 IAW VASRD §4.71a.  There were no other conditions within the panel’s scope of review for consideration.  The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Lumbago, Status Post Microlaminectomy at L4-L5 without Neurologic Abnormality	5299-5242	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150618, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170006465, XXXXXXXXXXXXXXXXXX.

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Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,