RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03529
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051026

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Motor Transport Operator, medically separated for “low back pain” with a disability rating of 10%.  

CI CONTENTION:  “It was not a ‘bladder’ issue it was a spinal issue with DDD [degenerative disc disease].”  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20050906	VARD - 20051115	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5299-5242	10%	Degenerative Lumbar Disc Disease	5110-5242	20%	STR	
			Urinary Bladder Disorder Associated with Degenerative Lumbar Disc Disease	7517	0%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Low Back Pain (LBP).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in 2003 after a heavy desk fell on him while he was carrying it down stairs.  A neurosurgical evaluation in April 2004 showed intermittent numbness of the right lower extremity (RLE) and three to four episodes of urinary incontinence.  An orthopedic evaluation in July 2004 noted a history of urinary dribbling, but no true incontinence.  An MRI showed DDD at L4-S1 with mild to moderate neuroforaminal narrowing, but no definite disc herniation or spinal stenosis.  Electrodiagnostic studies showed no evidence of RLE radiculopathy.  Surgery was not recommended.  However, the CI continued to report significant LBP and urinary dribbling associated with exacerbations of back pain.  MRI studies repeated in October 2004 and December 2004 were unchanged.  A second neurosurgical opinion on 18 January 2005 again recommended no surgical intervention.  However, an evaluation by a spine surgeon on 28 January 2005 the examiner assessed the CI’s LBP and urinary symptoms were likely due to DDD.  Surgical fusion was discussed, but the CI was advised that the natural history of DDD symptoms was generally favorable and surgery would not change his susceptibility to premature DDD.  

The CI was also evaluated by urology in January 2005 for his urinary symptoms.  The impression was that the CI’s bladder symptoms may be related to a central herniated disc and treatment with medication for the bladder symptoms was initiated.  Additional urologic testing, performed in March 2005, showed no evidence of voiding dysfunction.  A repeat MRI in March 2005 and computed tomography myelogram in May 2005 showed stable findings of DDD.  

At the 23 June 2005 physical therapy range of motion (ROM) examination, the CI had a normal gait and stance and was able to transfer easily during the evaluation.  Flexion was 55 degrees and combined ROM was 195 degrees, limited by pain.  The therapist documented pain with ROM without observed muscle guarding.  During the evaluation, the therapist described the CI as hostile and his cooperation as fair.  

During the 27 July 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported his leg went numb after sitting for a long time.  Physical examination showed a normal gait.  There was tenderness of the lumbar spine and pain with ROM.  Heel walking also increased his LBP.  

The 1 September 2005 (original examination was 4 April 2005) MEB NARSUM examination, 2 months prior to separation, noted complaints of LBP that interfered with sleep.  The examiner noted urologic testing showed no evidence of a neurogenic bladder.  Physical examination was described as “unremarkable.”  Gait was normal and the CI was able to weight bear on heels and toes.  There was tenderness of the low back at L5-S1.  During the examination, the CI was able to dress and undress normally.  The examiner indicated the CI was unable to work an 8-hour shift as a truck driver.  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5299-5242 (degenerative arthritis of the spine), citing tenderness and pain-limited motion.  The VA rated the back condition 20%, dual coded 5110-5242 (loss of use of both feet/degenerative arthritis of the spine [5110 appeared to the panel to be a typographical error in the VA Rating Decision, likely meant to be 5010 for traumatic arthritis]), based on the STR, citing pain-limited motion (forward flexion of 55 degrees).  

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, as reported on the physical therapy evaluation.  Although the physical therapist indicated the CI was not fully cooperative to examination, the panel consensus was that the clinical and imaging evidence in the STR supported resolving reasonable doubt in favor of the CI regarding his complaints of pain limiting his low back motion to flexion of 55 degrees.  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.  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 low back condition, coded 5243.  

BOARD FINDINGS:  In the matter of the back condition, the panel recommends a disability rating of 20%, coded 5243 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 the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Low Back Pain	5243	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170404, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180009197, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

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,					      
						      					
Enclosure