RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00061
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20090108

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Motor Transport Operator, medically separated for “degenerative arthritis of the spine” with a disability rating of 20%.  

CI CONTENTION:  “I was not allowed to see mental health before I was put on leave for separation from the Army.”  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 - 20081020	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Arthritis of the Spine	5242	20%	No VA Examination in Evidence	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  NA 	

ANALYSIS SUMMARY:  

Degenerative Arthritis of the Spine.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began during a 2005 deployment when her vehicle was hit by an improvised explosive device.   At a 29 April 2008 physical therapy (PT) visit, she reported low back pain (LBP) since redeploying 2006.  Examination revealed lumbosacral spine tenderness on palpation (TTP) with muscle spasm.  Trunk active range of motion (ROM) was limited in forward flexion with discomfort.  Straight leg raise (SLR) testing (to determine nerve root irritation) was negative for radiating symptoms, but increased the back pain with motion greater than 45 degrees.  Tests of the sacroiliac region were normal, but the examiner was unable to properly assess forward flexion due to the limited motion from pain.  Magnetic resonance imaging (MRI) studies on 5 May 2008, showed a mild disc bulge with degenerative disc disease at L5-S1.  A focal left lateral annular tear along the left lateral with disc protrusion at L5-S1 caused narrowing of the left lateral recess and left neural foramen (where nerves pass through the vertebral column).  No central spinal stenosis was indicated, but there were small 2-3 mm left lateral disc protrusions at L2-L3, L3-L4, and L4-L5.    

At a 12 August 2008 orthopedic visit, the CI reported continued back pain that had not improved with PT, epidural injections, nonsteroidal anti-inflammatory drugs, or activity limitation.  She had numbness of the feet and pain in the anterior thighs to the knees.  On examination, there was lumbar spine and sacroiliac joint TTP, but no muscle spasms or lumbosacral step deformities; SLR testing was positive.   Pain was recorded all ROMs and forward flexion was “fingertips to mid-thigh with pain.”  

During a 27 August 2008 orthopedic appointment, the CI was seated on the examination table and appeared very uncomfortable and in pain.  On examination, she had an antalgic gait, lumbar spine TTP and muscle spasms. Lower extremity strength was 3/5 bilaterally and lumbar ROM was significantly decreased with pain elicited by motion; SLR testing was positive. The examiner prescribed a steroid and narcotic/pain reliever. 

At a 5 September 2008 follow-up, the CI complained of chronic LBP, with pain radiating to the hips, thighs, legs and ankles, and made worse by activity.  She denied bowel or bladder problems and past surgical intervention.  Examination showed guarding of motion while standing and walking, but no use of assistive or orthotic devices.  She had pain with heel-toe walking and could not squat.   Trunk ROM was limited significantly by reversal of lordosis, but the CI was able to back bend with minimal difficulty and did not describe any pain in this position.  Straight leg testing was negative.  There was decreased sensation to the right lower extremity on all dermatomes from L2-S1, and muscle strength was 5/5 and symmetric bilaterally.  The examiner’s assessment was “mechanical back pain with bulging disc at L5-S1 with lower extremity symptoms, which did not appear to be of a radicular origin, but rather a referred type of pattern of distribution.”  At a PT visit on 17 September 2008, the examiner noted the CI had maximized her benefit after doing therapy for 6 months with no real change in symptoms.  

The 25 September 2008 MEB NARSUM examination, 4 months prior to separation, noted CI complaints of constant, stabbing chronic LBP rated at 6-8/10.  Pain intensity increased to 9/10 with aggravating activities such as walking, bending, running, or jumping.  Physical examination showed TTP of L4-L5 paraspinal muscles and negative bilateral SLR testing.  Upper and lower extremity muscle strength was 5/5 with deep tendon reflexes at 2/4.  Goniometric thoracolumbar ROM measurements were: active flexion to 40 degrees (normal 90) with a combined ROM of 110 degrees (normal 240).  All motions were painful, but there was no further limitation due to lack of endurance, fatigue, or incoordination with repetitive motion.  There was no VA examination proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 20%, coded 5242 (degenerative arthritis of the spine), citing painful and limited motion.  Members agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees and combined ROM (not greater than 120 degrees) and muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, as reported on the physical therapy and orthopedics examinations.  There was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the degenerative arthritis of the spine condition.  

BOARD FINDINGS:  In the matter of the degenerative arthritis of the spine condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161219, w/atchs
Exhibit B.  Service Treatment Record

AR20180003370, XXXXXXXXXXXXXXXXXX

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,					      
Enclosure