RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00752
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080520

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Human Resources Specialist, medically separated for “lumbar spondylosis” with a disability rating of 10%.

CI CONTENTION:  “Review all conditions.”  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 - 20080421	VARD - 20081128	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar Spondylosis	5299-5242	10%	Dextroscoliosis...with Lumbar Strain	5237	NSC	20081008	
Allergic Rhinitis	Not Unfitting	Allergic Rhinitis	6522	0%		
Mild Asthma		Asthma	6100	NSC		
Myopia		No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:

Lumbar Spondylosis.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s “lumbar spondylosis” (an age-related degeneration of intervertebral discs) condition began in August 2007 without specific injury or trauma.  Radiographic studies performed 16 October 2007 showed degenerative changes and electrodiagnostic studies performed 19 February 2008 were negative for radiculopathy.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.
At the time of the orthopedic clinic appointment on 27 February 2008, 3 months prior to separation, the CI reported low back pain with difficulty dressing, performing daily activities, lifting, and standing or sitting for extended periods.  Physical examination revealed spinal tenderness without muscle spasms.  Spinal appearance and gait were both normal.  The range of motion (ROM) was flexion reduced by 25% (approximately 70 degrees with normal 90); all other ROMs were reported normal; painful motion was not addressed.

At a physical therapy evaluation on 8 April 2008, one month before separation, physical examination revealed a normal gait with spinal tenderness and guarding.  There was no muscle spasm or abnormal spinal contour.  The goniometric-measured repetitive ROM was flexion to 70 degrees and combined ROM 140 degrees (normal 240) with painful motion.

During the 10 April 2008 MEB NARSUM, one month prior to separation, the CI reported low back pain which was exacerbated by activity.  The pain flare-ups were “tolerable” brought on by extensive use or inactivity, and lasted for one hour.  Physical examination showed spinal tenderness without guarding or muscle spasm.  The ROM was flexion to 20 degrees and combined ROM to 95 degrees (normal 240); painful motion was not addressed.

At the 8 October 2008 VA Compensation and Pension (C&P) evaluation, performed 5 months after separation, the CI reported intermittent moderate to severe low back pain with remissions.  She used a prescription non-steroidal anti-inflammatory (Celebrex), a nerve pain medication (Lyrica), and a local topical patch anesthetic (Lidoderm) for pain management.  The CI denied bowel and bladder symptoms, numbness, weakness, paralysis, and radiation of pain.  Physical examination showed the presence of guarding, but no spasm or tenderness.  The examiner indicated that guarding was not severe enough to result in the abnormal spinal contour observed; a flattening of the normal curvature of the spine.  Gait was normal, as was neurologic examination.  ROM was measured as flexion 90 degrees and combined ROM at 240 degrees.   Provocative testing for nerve root irritation was recorded as positive.  Radiographic studies showed no significant abnormalities.

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 guarding with a normal gait.  The VA did not service connect the back condition, coded 5237 (lumbosacral strain), based on the C&P examination 5 months after separation, citing the congenital or developmental nature of the dextroscoliosis (lateral curvature of the spine to the left) identified during the C&P examination radiographic studies.

The panel deliberated the probative value of the disparate back examinations and adjudged that the single MEB NARSUM examination documenting flexion to 20 degrees was not consistent with the preponderance of the other STR and VA examinations.  Panel members placed higher probative value on the other STR and VA examinations in rating the CI’s low back pain at the time of separation.

The panel agreed there was insufficient limitation of motion to support a minimum rating, however, a 10% rating was justified for localized tenderness not resulting in an abnormal gait.  There was no documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes which would provide for a higher rating under that alternate VASRD formula.

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the lumbar spondylosis.

Contended PEB Conditions:  Allergic Rhinitis, Mild Asthma, and Myopia.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled, implicated in the commander’s statement, or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the lumbar spondylosis and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended allergic rhinitis, mild asthma and myopia, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There are 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 20150602, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170007008, XXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXXXX:

	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,