RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01840
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090713

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Infantryman, medically separated for “intervertebral disc syndrome,” with a disability rating of 20%.

CI CONTENTION:  “Lower back pain.”  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 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 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 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 panel has neither the role nor the authority to compensate for progression or complications of service-connected conditions after separation.  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 – 20090518	VARD - 20090911	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Intervertebral Disc Syndrome	5243	20%	Degenerative Disc Disease, Lumbar Spine	5237	0%	20090811	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Intervertebral Disc Syndrome.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back pain condition began during his deployment to Iraq in April 2008, without any specific injury or trauma.  A magnetic resonance imaging (MRI) study on 6 November 2008 showed a broad based L5-S1 herniated disc bulge, causing bilateral neural foramen (nerve root opening) narrowing, which does not appear to compress the nerve roots.  The 11 February 2009 electrodiagnostic (EDX) study (electromyogram [EMG]/nerve conduction velocity [NCV]) of the left lower extremity was normal.  A 14 April 2009 lumbosacral spine radiographic (X-ray) study revealed very mild L5-S1 disc space narrowing.  The evaluation by orthopedic surgery on 24 February 2009 noted that the CI was not a surgical candidate.  

During the 26 February 2009 MEB examination (recorded on DD Forms 2807 and 2808), 5 months prior to separation, the CI reported no recurrent back pain or any back problem.  Physical examination showed a normal spine.  

On 6 March 2009, physical therapy (PT) measured range of motion (ROM) with a goniometer for the MEB.  The thoracolumbar spine examination revealed guarding, but no abnormal spinal contour, or abnormal gait due to muscle spasm or guarding.  ROM measurements showed a flexion of 60 degrees (normal 90) and a combined ROM of 155 degrees (normal 240).  There were 4/8 positive Waddell’s signs (psychogenic, or nonorganic, manifestations of pain).  

The MEB NARSUM examination on 7 May 2009 (2 months prior to separation) noted complaints of low back pain.  The physical examination documented an unremarkable gait.  The back examination revealed L2 to S1 tenderness, lower back paravertebral muscle spasm and guarding, and slight straightening.  ROM measurements for PT on 6 March 2009 showed a flexion of 60 degrees and a combined ROM of 155 degrees, with no radicular (nerve root irritation or injury) signs and 4/8 Waddell’s signs were positive.  Strength, deep tendon reflexes (DTRs), and sensation were normal except for left 5th toe numbness.  The examiner recounted the findings of the EDX, X-rays, and MRI.  

At the 4 August 2009 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI complained of back pain following an air assault mission.  The physical examination documented a normal posture and gait with no ambulatory aids.  Thoracic and lumbar spine ROM was full.  Strength, DTRs, and sensation were normal and pathologic reflexes were absent.  In the 11 August 2009 VA C&P spine examination, 1 month after separation, the CI complained of back pain with occasional radiation to the left calf.  He reported pain was 3/10 at rest, 8-10 with activity, and denied incontinence and erectile dysfunction.  The physical examination documented a normal gait.  The back examination revealed normal paraspinous muscle tone, a normal lumbar curve, and no scoliosis (abnormal lateral spine curvature).  Pain-free thoracolumbar ROM showed a normal flexion of 90 degrees and normal combined of 240 degrees.  There was no additional decrease in ROM with repetitive (X3) movement due to pain, weakness, excess fatigability, or incoordination.  The straight leg raise ([SLR] assess for herniated disc causing sciatic nerve root [L5-S1] radiculopathy) tests were negative.  Strength, DTRs, and sensation were normal and pathologic reflexes were absent. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 20%, coded 5243 (intervertebral disc syndrome), citing presence of paraspinal tenderness, spasm, guarding, and ROM.  The VA rated the back condition 0% coded 5237 (lumbosacral strain), based on the VA C&P examination 1 month after separation, citing full ROM, with no evidence of painful motion or other functional loss, are consistent with a non-compensable evaluation.  The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees) reported on the PT examination for the MEB.  The panel also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  There was no associated radiculopathy for separate peripheral nerve rating.  While the CI may have experienced radiating pain from the back condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  There was no objective evidence of a radiculopathy with functional impairment (such as weakness) that directly impacted fitness for duty.  The panel therefore concluded that an additional disability rating was not justified on this basis. The panel concluded there was no evidence to support a rating higher than the rating adjudicated by the PEB.  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 back condition.  

BOARD FINDINGS:  In the matter of the intervertebral disc syndrome condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150707, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170009173, XXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	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