RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00959
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040130

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty CW3, AH-64 Pilot, medically separated for “lumbar degenerative disk disease (DDD)” with a disability rating of 0%.

CI CONTENTION:  “All conditions should be evaluated.”  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 - 20031113	VARD - 20040506	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar DDD	5299-5237	0%	Lumbar DDD	5243	10%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Lumbar DDD.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in 1999 with complaints of low back and hip pain, and left lower extremity weakness and paresthesias.  An MRI in 2001 revealed a herniated nucleus pulposus at the L4-L5. 

The 25 July 2003 MEB NARSUM examination, 6 months before separation, noted complaints of lumbar pain, left hip pain and left lower extremity numbness and tingling.  Physical examination showed no spinal tenderness and range of motion (ROM) had decreased flexion.  Gait, spinal contour, spasm and painful motion were not addressed. An MRI in September 2003 showed mild to moderate degenerative changes at L4-5 and L5-S1.  Electrodiagnostic studies on 8 October 2003 were negative for left lower extremity radiculopathy. 
During the 15 October 2003 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported intermittent paresthesias.  Physical examination showed decreased ROM; painful motion was not addressed.  At the November 2003 MEB physical therapy (PT) appointment, 3 months before separation, physical examination showed active flexion to 100 degrees (normal 90) and combined ROM 225 degrees (normal 240); painful motion was not addressed.  There was no VA Compensation and Pension examination in evidence. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the lumbar spine condition 0%, analogously coded 5299-5237 (lumbosacral strain), citing combined thoracolumbar ROM.  The VA rated the lumbar spine condition 10%, coded 5243, (intervertebral disc disease), based on the STR, citing decrease ROM. The panel carefully reviewed the ROM conducted by PT which recorded 25 degrees of extension (normal 30) and a 20-degree right side bend (normal 30), with all other ROM measurements normal or greater.  The decrease of extension and right side bend reduced the combined ROM to 225 degrees.  The panel agreed, the 10% rating was justified for the combined ROM of 225 degrees.

There was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula.  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 impairments (such as weakness) that directly impacted fitness for duty.  The panel therefore concluded that 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 recommends a disability rating of 10% for the lumbar DDD condition, coded 5299-5237.

BOARD FINDINGS:  In the matter of the lumbar DDD condition, the panel unanimously recommends a disability rating of 10%, coded 5299-5237 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends 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	5299-5237	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160922, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170019687, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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