RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05801
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070920

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Optical Lab Specialist, medically separated for “lumbar degenerative disc disease [DDD]” with a disability rating of 10%.  

CI CONTENTION:  Review requested of the back condition and additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 -20070904	VARD - 20080124	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar DDD w/o Motor Neurologic Deficit	5299-5242	10%	Degenerative Arthritis, Thoracic and Lumbar Spine	5242	10%	20071029	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Lumbar DDD.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s chronic low back pain began in 2005 after performing a squat with approximately 220 lbs.  He experienced low back and right lower extremity pain.  Treatment was conservative.  An MRI in July 2006 showed disk protrusion at L4-5 and L5-S1 with mass effect on the adjacent nerve root.  Electrodiagnostic studies were declined due to resolving symptoms.

During the 9 April 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, physical examination showed mild tenderness, motor strength 5/5 and reflexes 2/4.  Range of motion (ROM) showed flexion 90 degrees (normal), with combined ROM at 255 degrees (normal 240).  At the same-day MEB NARSUM examination, the CI reported pain 50% of the time during his daytime hours.  Physical examination showed mild diffuse tenderness without a palpable step off.  No tenderness was noted over the sacroiliac joint.  The remainder of the examination was unchanged from MEB examination.

At the 29 October 2007 VA Compensation and Pension (C&P) examination, one month after separation, the CI reported stiffness with bending down or ROM and weakness with running, or lifting heavy items.  Pain occurred 20 times per day and lasted for a half hour traveling down thought the right leg.  Physical examination showed no evidence of radiating pain on movement.  Muscle spasms were absent, straight leg raise testing was negative and there was no tenderness.  ROM showed flexion 90 degrees with combined ROM at 240 degrees.  Pain was the major functional impact after repetitive use.  The spine was normal in appearance.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB and the VA rated the lumbar DDD 10%. The PEB analogously coded 5299-5242 (degenerative arthritis of the spine) citing no limitation of thoracolumbar ROM.  The VA coded 5242 based on the C&P examination, citing forward flexion greater than 60 degrees but not greater than 85 degrees.  The panel agreed that although there was insufficient limitation of motion to support a 10% rating, a 10% rating was justified for the presence of painful motion and tenderness.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no evidence of intervertebral disc syndrome which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula for that condition.  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.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the lumbar DDD.  

BOARD FINDINGS:  In the matter of the lumbar degenerative disc disease and IAW VASRD §4.71, the panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.  

 

ARXXXXXXXXXXX, XXXXXXXXXXXXX. 

Dear XXXXXXXXXX:

	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