RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00876
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030921

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Field Artillery Cannoneer, medically separated for “chronic low back pain (LBP), status post (S/P) L5-S1 fusion in treatment of spondylolisthesis," with a disability rating of 10%.  

CI CONTENTION:  “Review all conditions.”  The CI made no specific contention.  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 - 20031106	VARD - 20040628	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP, S/P L5-S1 Fusion…	5293 5299-5295	10%	Spondylolisthesis Sacral Spine, S/P Laminectomy	5239	0%	20040508	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic LBP, S/P L5-S1 Fusion….  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back condition began in 1998 with no history of trauma.  Radiographic evaluation (X-rays in 1999 and MRI in 2001) showed grade III spondylolisthesis (51-75% slippage) of the L5-S1 vertebrae with bilateral fractures (pars defects).  Surgery (lumbosacral fusion) was performed in November 2001.  At a 2 October 2003 internal medicine visit, 10 months prior to separation, the range of motion (ROM) was recorded as “normal.”  

At the 11 December 2002 MEB examination (recorded on DD Forms 2807 and 2808), 8 months prior to separation, the physical examination showed “decreased” ROM.  At a 20 February 2003 physical therapy (PT) visit, 6 months prior to separation, ROM measurements showed a forward flexion of 60 degrees (normal 90), extension of 15 degrees, left side bending to 25 degrees (normal 30) and right side bending to 30 degrees.  At the 3 April 2003 MEB NARSUM examination, 4 months prior to separation, the CI reported difficulty with excessive bending or squatting, standing greater than 15 minutes, and inability to run.  The physical examination showed normal lumbar curvature with no evidence of muscle spasm or wasting, and normal gait, reflexes, and sensation.  The examiner referenced the February 2003 PT ROM measurements.  There was no STR documentation of incapacitating episodes having a total duration of at least 2 weeks to 4 weeks, and no documentation of spasm or marked limitation on forward bending, Goldthwaite sign, abnormal mobility on forced motion, or loss of lateral spine motion.  

At the 8 May 2004 VA Compensation and Pension (C&P) evaluation, 9 months after separation, the CI reported “seldom” having back pain (2-3 episodes per month), however did have 2-3 flare ups per year without episodes of incapacitation.  The physical examination showed normal gait and normal lumbar curvature, flexion to 90 degrees without pain, and bilateral side bending to 30 degrees.  There was no evidence of pain, spasm, or fatigability on repetition.  Radiographic evaluation (X-rays) from December 2003 showed a stable post-surgical spinal fusion with no compression defects.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated 10% for the low back condition, analogously coded 5293-5299-5295 (intervertebral disc syndrome; lumbosacral strain), citing painful motion, with no evidence of chronic spasms or neurologic abnormality.  The VA rated 0% for the low back condition, coded 5239 (spondylolisthesis), based on the VA C&P examination 9 months after separation, citing no objective evidence of pain, full ROM, normal gait, with no post-surgical residuals.  

At the time of separation in September 2003, the 2003 standards for rating based on ROM impairment were subject to the rater’s opinion regarding degree of severity; whereas, the current standards specify rating thresholds in degrees of ROM impairment.  When older cases have ROMs in evidence, the Board reconciles (to the extent possible) its opinion regarding degree of severity for the older spine codes.  There was no documentation of incapacitating episodes having a total duration of at least 2 weeks to 4 weeks for a higher rating under 5293 (intervertebral disc syndrome).  There was no documentation of spasm or marked limitation on forward bending, Goldthwaite sign, abnormal mobility on forced motion, or loss of lateral spine motion in support of a higher rating under code 5295 (lumbosacral strain).  The measurements in evidence were not consistent with a ‘moderate’ limitation of motion of the lumbar spine in support of a higher rating under code 5292.  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 low back condition.  

BOARD FINDINGS:  In the matter of the low back condition and IAW 2003 VASRD, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150601, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170007148, 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,