RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2017-00395
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090108

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

CI CONTENTION:  The CI requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the MEB, but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20081204	VARD - 20090810	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Arthritis of the Spine	5242	20%	Degenerative Disc Disease with Arthritis, Thoracolumbar Spine	5243-5242	20%	20090701	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Degenerative Arthritis of the Spine.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s spine condition began in June or July 2007 when he was on a combat mission in a HUMVEE and the driver suddenly drove off a bridge causing a 50–caliber ammunition load to strike the CI behind the head and neck injuring his mid and lower back.  The CI was evaluated for mid to low back pain and treated conservatively with nonsteroidal anti-inflammatory agents, muscle relaxers, physical therapy, and a physical profile.  Surgery was not recommended.  A lumbosacral MRI in June 2008 showed L5-S1 disc bulges.
The 23 September 2008 MEB physical therapy (PT) examination, 4 months prior to separation, showed goniometric-measured repetitive thoracolumbar flexion to 35 degrees (normal 90) and combined range of motion (ROM) was 155 degrees (normal 240) with painful motion.  The 17 October 2008 MEB NARSUM examination, 3 months prior to separation, noted complaints of severe mid-to-low back pain aggravated by sudden rapid movement.  Physical examination showed a normal gait without spinal spasm or guarding, but tenderness was present.  Repetitive “back” flexion was 70 degrees and combined ROM was incomplete.  Painful motion was elicited.

At the 1 July 2009 VA Compensation and Pension (C&P) examination, 6 months after separation, the CI reported daily back pain with flare-ups that occurred in the morning and with prolonged sitting.  Physical examination showed spinal tenderness and normal spinal alignment and gait.  Lumbosacral flexion was 70 degrees and combined ROM was 200 degrees with painful motion.  Flexion was reduced to 50 degrees due to pain following repetitive use

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the spine condition 20%, coded 5242 (degenerative arthritis of the spine) citing spinal flexion to 45 degrees. The VA also rated the spine condition 20%, dual coded 5243-5242 (intervertebral disc syndrome (IVDS)-degenerative arthritis of the spine), based on the C&P examination, citing limitation of flexion.  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 PT and VA ROM examinations.  There was no documentation of IVDS with incapacitating episodes which would provide for a higher rating under that formula.  After due deliberation, considering all 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 spine condition.

BOARD FINDINGS: In the matter of the spine condition and IAW VASRD §4.71, the panel 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 20170215, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190008804, 

Dear XXXXXXXXXXXXXXX:

	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.