RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00391
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20080103

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Infantryman, medically separated for “intervertebral disk syndrome” with a disability rating of 10%.  

CI CONTENTION:  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 - 20071128	VARD - 20080411	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Intervertebral Disk Syndrome	5243	10%	Degenerative Disc Disease L4-L5, L5-S1, with Impingement of S1 Nerve Root	5243	20%	20080328	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Intervertebral Disk Syndrome.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in February 2006 without any specific injury or trauma.  Lumbar spine magnetic resonance imaging (MRI) on 17 April 2006 showed degenerative disc disease with disk protrusions at L4-5 and L5-S1 causing moderate narrowing of the neural foramen (space through which the spinal nerve root passes) bilaterally, and possible S1 nerve root impingement on the left.  At the 21 May 2007 neurosurgery appointment, 8 months before separation, the CI reported pain in his back that did not radiate to his legs and was aggravated with sitting and standing.  Physical examination showed normal strength without atrophy in his quads, hamstrings, foot dorsiflexors, plantar flexors, decreased sensation on the top of the left foot, and brisk reflexes bilaterally.  The neurosurgical assessment was that neither disc protrusion was causing nerve root compression and surgery was not indicated at the time.  The CI continued to experience significant back pain and conservative treatment, including epidural steroid injections, physical therapy, muscle relaxants, and other medications were not successful in enabling him to return to full military duty.  

The 13 November 2007 MEB NARSUM examination, 2 months prior to separation, noted complaints of chronic pain lower back pain with left lower extremity radicular symptoms, graded 7-8/10.  Physical examination showed tenderness to palpation of the paraspinal muscles of L5-S1.  Thoracolumbar range of motion (ROM) measurements showed flexion of 40 degrees (normal 90) and combined ROM of 125 degrees (normal 240) with painful motion.  The examiner was silent regarding spasm/guarding, gait, and spinal contour.  

At the 28 March 2008 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported lower back pain, running down his left leg to his ankle, usually a dull ache with occasional stabbing pain.  Physical examination showed no muscle spasm, guarding, or tenderness and a normal gait.  Thoracolumbar ROM measurements showed flexion of 50 degrees (normal 90) and combined ROM of 185 degrees (normal 240) after repetition with painful motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5243 (intervertebral disc syndrome), citing tenderness and stating that there were no clinical signs of separately unfitting radiculopathy.  The VA rated the back condition 20%, coded 5243 (intervertebral disc syndrome), based on the C&P examination 3 months after separation, citing forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees.  

The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees) as reported on the MEB NARSUM and the VA examinations.  The panel considered whether a higher rating (§4.7) was achieved by using the alternate rating formula based on incapacitating episodes due to intervertebral disc syndrome (IVDS).  Although the CI had intervertebral disc disease, there were no incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under that alternate VASRD formula.  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 5243.  

BOARD FINDINGS:  In the matter of the back condition, the panel unanimously recommends a disability rating of 20%, coded 5243 IAW VASRD §4.71a.  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	
Intervertebral Disk Syndrome	5243	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160705, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170015491, 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