RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01329
BRANCH OF SERVICE:  cOAST gUARD 	SEPARATION DATE:  20091013

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Machinery Technician, medically separated for “spondylolisthesis, spine,” with disability rating of 20%.  

CI CONTENTION:  The applicant makes no specific contention in his application.  His 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 confined to 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 - 20090309	VARD - 20091007   	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Spondylolisthesis, Spine	5239	20%	Post-Operative Pain Syndrome Following Posterior Spinal Fusion 4th and 5th Lumbar Spine	5242	20%	20090714	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Spondylolisthesis, Spine.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent 2 back surgeries: a lumbosacral fusion (L5-S1 vertebral levels) in December 2007 for low back pain, and a mid- thoracic posterior stabilization surgery (T3-L2 vertebral levels) in June 2008 for Scheuerman’s deformity (excessive forward spinal curvature).  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB “chronic low back pain,” “lumbar spondylolisthesis,” “Scheuermann’s kyphosis” and “herniated disc” for PEB adjudication.  

At a visit with physical therapy in October 2008 (5 months post-surgery; 12 months pre-separation), the examiner documented tenderness, painful motion and a flexion of 30 degrees with repetition.  An orthopedic appointment on 31 December 2008 (10 months pre-separation), the CI reported continued pain radiating to the anterior chest wall.  On examination, there was normal strength and a normal gait.  Forward flexion was limited to “18 inches from the floor” which approximates 60 degrees of thoracolumbar flexion.  At a follow-up orthopedic visit in June 2009 (4 months pre-separation), the CI reported night awakenings and no improvement of the pain.  Physical exam showed a normal gait, flexion to 60 degrees, and normal strength, reflexes and sensation.  At an orthopedic visit in August 2009 (2 months pre-separation), the CI reported little change in pain intensity and frequency after 2 steroid injections (in July 2009).  Physical examination showed a normal gait, normal strength of the lower extremities, and no discomfort while seated.  

At the 14 July 2009 VA Compensation and Pension (C&P) evaluation (3 months post-separation), the CI reported constant mid and upper thoracic pain radiating to the anterior chest and down to the left lower extremity, made worse with activity, exercise, and prolonged sitting and standing.  He reported increased pain after walking 2 blocks and denied falls and use of assistive devices or braces.  The examiner did not describe any abnormalities related to ambulation, sitting, standing, squatting, or heel/toe walk.  Tenderness, spasm (“twitching”), abnormal spinal curvature and painful motion were noted.  Flexion was to 50 degrees with no additional changes after repetition.  Sensation and reflexes were normal.  There was weakness (not quantified) noted with left lower extremity flexion and extension.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB rated 20% for the “spondylolisthesis, spine” condition, and coded 5239 (spondylolisthesis), citing muscle spasms severe enough to result in abnormal spinal contour.  The VA also rated 20% for the “post-operative pain syndrome following posterior spinal fusion…” condition and coded 5242 (degenerative arthritis of the spine), based on the VA C&P examination 3 months post-separation, citing restricted range of motion.  

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).  Although the October 2008 physical therapy entry documented a forward flexion of 30 degrees, all subsequent orthopedic and VA C&P examinations (pre- and post-separation) had documented improvement with consistent flexion measurements greater than 50 degrees, or spasms with abnormal curvature in support of a 20% rating.  The Board agreed that these examinations were most probative to the rating and were most reflective of the CI’s disability at the time of separation.  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 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 concluded that there was insufficient cause to recommend a change in the PEB adjudication for the spine condition.  

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

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140310, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

Commandant
United States Coast Guard	Mail Stop 7907
2703 Martin Luther King Jr. Ave SE
Washington, DC 20593-7907
Staff Symbol: CG-1
Phone: (202) 475-5000

								   1850

Dear XXXXXXXXXX,
I am the Designated Decision Authority for the Coast Guard on applications submitted to the Department of Defense Physical Disability Board of Review (PDBR).  Under the authority of Title 10, United States Code, section 1554a, I accept the PDBR’s recommendation in your case (Case Number PD-2014-01329) and decline to modify your findings. 

Enclosed for your information are a copy of the PDBR’s recommendation and a copy of the record of proceedings. 

A copy of this decision has also been provided to Coast Guard Enlisted Personnel Management Branch, the PDBR, and the Department of Veterans Affairs. 

If you have any further questions, please contact the Coast Guard Personnel Service Center at (202)795-6645. 
	Sincerely,
2 Enclosures		
	
Copy:	CG Personnel Service Center (EPM-1)
DoD Physical Disability Board of Review
Department of Veterans Affairs