RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02435
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070608

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Automated Logistics Specialist, medically separated  for “lumbar degenerative disc disease (DDD),” with a disability rating of 10%.  

CI CONTENTION:  The CI contends that the rating for her back condition be changed.  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 – 20070517	VARD - 20071110	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar DDD	5299-5242	10%	Lumbar DDD L4-S1	5010-5242	20%	20070615	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Lumbar DDD.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in 1996 after heavy lifting.  She had significant exacerbations in 1997, 2000, 2003, and 2005, but was always able to return to her normal military duties.  However, in June 2006, after another lifting injury, her back pain became chronic.  Radiographic studies showed DDD with disc protrusions and canal stenosis at L4-5 and L5-S1.  Electrodiagnostic studies, performed on 28 December 2006, demonstrated evidence of polyradiculopathy consistent with spinal stenosis.  Evaluation by orthopedics concluded with a diagnosis of lumbar spondylosis and recommended non-surgical treatment.  Despite treatment, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  The MEB forwarded “chronic lower back pain secondary to protruding lumbar disks with radicular symptoms down the left leg” 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 ~4 Mos. Pre-Sep	NARSUM ~1 Mos. Pre-Sep	VA ~7 Days Post-Sep	
Flexion (90 Normal)	65	65	60	
Combined (240)	215	215	160	
Comments	Painful motion; spasm; inclinometer (see text)	Painful motion; tenderness; spasm; inclinometer (see text)	Painful motion; tenderness; guarding with normal gait and posture	
§4.71a Rating	10%	10%-20%	20%	

During the MEB examination (recorded on DD Forms 2807 and 2808) dated 10 January 2007, 5 months prior to separation, the CI reported back pain that radiated to the legs, mainly the left leg.  She also described numbness and tingling in the left leg.  Physical examination showed decreased left lateral flexion and left rotation, but did not include the actual measurements.  Pain was elicited with flexion, left rotation and left lateral flexion.  There was tenderness, but no mention of spasm.  The CI had an antalgic gait.  Provocative testing for radiculopathy (SLR) was negative and the CI had normal motor strength.  The physical therapy (PT) ROM study on 26 January 2007, 4 month prior to separation, noted complaints of low back pain with radiating pain in the left lower extremity above the knee.  Pain level was 7 out of 10.  Physical examination showed decreased ROM due to pain as indicated in the chart above.  ROM measurements were taken with an inclinometer except for the measurements of rotation which were taken with a goniometer.  There was no localized tenderness.  The CI had muscle spasm; but, no abnormal gait or abnormal spinal contour due to spasm or guarding.  

The MEB NARSUM examination on 27 April 2007, 1 month prior to separation, noted complaints of radiating pain to the left lower extremity and pain with lifting, bending or stooping.  Physical examination showed decreased flexion due to pain as indicated in the chart above.  The NARSUM recorded ROM measurements were precisely the same values as the average ROMs from the physical therapy ROM study conducted on 26 January 2007.  The NARSUM stated the ROMs were taken with an inclinometer except for the measurements of rotation which were taken with a goniometer.  The CI had muscle spasm, but no guarding and no abnormal spinal contour.  However, the description of the CI’s gait was equivocal.  In one place in the examination it stated “no abnormal gait,” but later in the same paragraph it reflected:  “Gait noted the patient with a limp favoring the left.”  There was paraspinal tenderness.  Provocative testing for radiculopathy was negative and the CI had normal motor strength and sensation.  

At the 15 June 2007 VA Compensation and Pension (C&P) evaluation, performed 7 days after separation, the CI reported back pain at the 7-9/10 level with radiation of pain down the left leg.  She had flare-ups with bending activities without incapacitation.  Physical examination showed decreased ROM as indicated in the chart above after repetitive motion due to pain, with the exception of extension where there was no pain.  There was paravertebral tenderness, but no spasm.  The CI demonstrated mild to moderate guarding, but had normal gait and posture.  Sensation, reflexes, and strength in the lower extremities were normal and provocative testing for radiculopathy was negative.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded analogous to 5242 (degenerative arthritis of the spine), citing “ROM limited by pain; positive spasm; no abnormal gait related to back contour.”   The VA rated the back condition 20% coded 5010-5242 (traumatic arthritis of the spine), based on the VA C&P examination 7 days after separation, citing limitation of forward flexion greater than 30 degrees but not greater than 60 degrees.  The Board noted the PT and NARSUM examinations provided ROM values for the thoracolumbar spine performed using an inclinometer for the flexion, extension, and lateral flexion measurements, and not the goniometric thoracolumbar measurements specified by VASRD §4.46 (accurate measurement).  The NARSUM ROM values were almost certainly taken from the physical therapy ROM study done 3 months earlier, and not a separate ROM measurement accomplished the date of the NARSUM.  The Board also noted that the NARSUM examination was equivocal in regards to whether or not the CI’s gait was normal or abnormal.  The VA examination was performed most proximate to separation; was more complete than the other examinations in evidence; and included testing for functional loss due to repetitive motion.  Therefore, the Board assigned more probative value to the VA examination conducted proximate to separation.  The Board 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 VA examination.  

The Board considered whether a higher rating (§4.7) was achieved by using the alternate rating formula based on incapacitating episodes due to intervertebral disc syndrome (IVDS).  Although the CI had intervertebral disc disease there were insufficient incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of any higher rating under the alternate VASRD formula (for IVDS).  The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI had symptoms of radiating pain documented in the treatment records, as well as left leg paresthesias (abnormal sensations); however, examinations indicated normal strength, sensation, and reflexes.  Radiographic and electrodiagnostic studies supported some level of radicular nerve irritation or involvement, but physical examinations (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).”  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 Board 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 Board recommends a disability rating of 20% for the back condition, coded 5242.  

BOARD FINDINGS:  In the matter of the back condition, the Board unanimously recommends a disability rating of 20%, coded 5242 IAW VASRD §4.71a.  

The Board 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	
Lumbar DDD	5242	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20151013, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170004625, XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

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,
Enclosure