RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01551
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070528

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Multichannel Transmission Operator/Maintainer, medically separated for “thoracolumbar degenerative disc disease” with a disability rating of 10%.

CI CONTENTION:  The CI requested a review of 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 - 20070410	VARD - 20070824	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Thoracolumbar Degenerative Disc Disease	5242	10%	Thoracolumbar Degenerative Joint Disease	5237	10%	20070723	
Right SI [Sacroiliac] Joint Pain	Not Unfitting	No VA Placement	
Adjustment Disorder with Anxiety	Not Unfitting	Anxiety Disorder	9413	10%	20070803	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Thoracolumbar Degenerative Disc Disease (DDD).  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in March 2006 without any specific injury or trauma.  Radiographic studies showed DDD with bulging intervertebral discs at L4-5 and L5-S1.  The CI initially complained of bilateral lower extremity tingling and pain, but there was no surgical indication.

At the time of the physical therapy (PT) clinic appointment on 4 January 2007, the CI reported pain in his mid-back on the right side.  His back pain was aggravated by running, sit-ups, lifting, walking for long distances or performing a lot of push-ups.  Physical examination showed tenderness of the right thoracic paraspinal muscles.  His active range of motion (ROM), posture, and gait were all normal, although ROM measurements were not performed.

During the NARSUM examination dated 8 March 2007, 3 months prior to separation, the examiner recorded that the CI had chronic low back pain, but no longer had lower extremity numbness or tingling.  It was also noted that he was undergoing treatment for right sacroiliac (SI) joint pain with steroid injections.  Physical examination showed “decreased active ROM in all planes, secondary to pain,” but the examiner did not include goniometric measurements.  There was no muscle spasm or abnormal spinal contour and his gait was normal.  At the MEB PT ROM study on 16 March 2007, 2 months prior to separation, the CI reported right-sided low back pain, which he rated 3/10 in severity.  Physical examination showed painful, limited motion.  Lumbar paraspinal muscle tenderness was present.  Although the gait was slow and cautious, a “normal stride length and cadence” was described.  There was no muscle spasm or mention of guarding, and spinal contour was normal.  Thoracolumbar flexion was 55 degrees after 3 repetitions (65, 55, 54; normal 90).  Combined ROM was 145 degrees (normal 240).  Flexion and extension were measured with an inclinometer and the remaining parameters with a VASRD-required goniometer.  The MEB addendum examination on 3 April 2007 showed lumbar and right SI joint tenderness.  Walking on heels and toes was observed to be normal.

At the 23 July 2007 VA Compensation and Pension (C&P) evaluation, performed 2 months after separation, the CI reported back pain with walking after 1 hour, sitting greater than 2 hours, lifting greater than 40 pounds, or bending.  Flare-ups of pain were denied.  Physical examination showed normal walking on heels and toes and normal spine alignment.  Muscle spasm was absent and guarding was not mentioned.  ROM was limited by pain.  Thoracolumbar flexion was 45 degrees.  Lateral flexion was 30 degrees (normal 30) bilaterally, but rotation measurements were not performed.  ROM was not additionally limited with repetition.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5242 (degenerative arthritis of the spine), citing painful limitation of motion and tenderness.  The VA also rated the back condition 10% coded 5237 (lumbosacral strain), based on the VA C&P examination 2 months after separation.  The only two examinations in evidence that provided measured ROM were the MEB PT study and the C&P evaluation, and both suffered some probative value compromise.  Although the PT evaluation supported a 20% rating for flexion not greater than 60 degrees, the measurement was performed with an inclinometer, which does not correlate well with the VASRD-required goniometer.  The C&P examination was incomplete since it did not include measurement of rotation, thus an accurate assessment of combined ROM was not possible.  However, it did include flexion of 45 degrees, which supported a 20% rating, but no higher, for limitation of flexion greater than 30 degrees but not greater than 60 degrees.  Although the CI had DDD, 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 that alternate VASRD formula (for IVDS).  The panel finally considered that the PEB adjudicated right SI joint pain as not unfitting.  However, it should be noted that the low back condition already accounts for the SI joint IAW VASRD §4.66 (sacroiliac joint), which stipulates, “The lumbosacral and sacroiliac joints should be considered as one anatomical segment for rating purposes.”  Therefore any disability from the sacroiliac joint was subsumed in the rating for the thoracolumbar spine, and the PEB’s adjudication of “not unfitting” is moot.  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 back condition, coded 5242. 

Contended PEB Condition:  Adjustment Disorder with Anxiety.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  A psychiatric memorandum on 8 March 2007 indicated that the CI was diagnosed with adjustment disorder that did not interfere with his ability to function in the military setting.  The commander’s statement indicated that only physical problems limited his ability to perform his duties.  The contended condition was not profiled or judged to fail retention standards.  There was no performance-based evidence from the record that the condition 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 the adjustment disorder and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the back condition, the panel unanimously recommends a disability rating of 20%, coded 5242 IAW VASRD §4.71a.  In the matter of the contended adjustment disorder condition, the panel unanimously recommends no change from the PEB determination as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Lumbar DDD	5242	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150622, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170008822, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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