RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01196
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20090121

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Test, Measurement and Diagnostic Equipment Maintenance Support Specialist, medically separated for “intervertebral disc syndrome, lumbar spine” with a disability rating of 10%.  

CI CONTENTION:  “All documents on file indicate the extreme level of condition and shows worsening over time.”  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 Medical Evaluation Board (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 - 20081008	VARD - 20090924	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Intervertebral Disc Syndrome, Lumbar Spine…	5243	10%	Lumbar Strain	5237	20%	20090430	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Intervertebral Disc Syndrome, Lumbar Spine.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back condition began in May 2008 after playing football for physical training.  X-rays on 19 May 2008, 8 months prior to separation, revealed vertebrae were intact and alignment was satisfactory.  The disc spaces were preserved.  The impression was “Intact lumbar spine.  No fracture or subluxation.”

At the time of the orthopedic clinic appointment on 2 July 2008, 6 months prior to separation, the CI reported complaints of back pain with pain radiating down his leg.  He had pain extending down to the lateral aspect of his leg with some paresthesias.  Physical examination showed a normal heel and toe walk and an “erect stance.”  Repetitive tiptoe raises were normal.  There was mild lumbosacral tenderness.  Thoracolumbar range of motion (ROM) showed pain with flexion past 60 degrees (normal 90) at the lumbosacral area and right buttock area and pain with extension.  He had a positive straight leg raise on the right at 80 degrees, negative on the left.  His sensory and vascular examination was intact.  

An MRI on 8 July 2008, 6 months prior to separation, revealed a small central disc herniation narrowing the spinal canal slightly.  There was mild degenerative facet change.  Moderate broad‑based bulging annulus narrowing the spinal canal was noted.  There was a small annular tear identified centrally and a degenerative change in the facet joints.  The mid and upper lumbar and lowermost thoracic interspaces were normal.  The vertebral body marrow signal appeared normal.  The conus terminated normally in the upper lumbar region and the paraspinal soft tissues were normal.  The impression was degenerative disc and degenerative facet change lower lumbar region.  

The 18 September 2008 MEB NARSUM examination, 4 months prior to separation, noted complaints of constant low back pain (5-7/10) with bilateral radicular symptoms worse below his knees, left equal to the right.  The CI experienced tingling from his knee to the foot and pain occurred through all waking hours.  He reported the pain felt like a pressure sensation all across his lumbar region and lower back.  Physical examination showed a normal gait, which included a heel and toe walk.  There was right paraspinous muscle spasm with tenderness in the lumbar region without loss of normal lordosis.  He had negative straight leg raising tests, bilaterally.  Neurovascular examination was intact.  Thoracolumbar ROM showed decreased flexion and side bending (left greater than right).  Extension and lateral rotation appeared to be intact.  

At the physical therapy clinic appointment on 23 September 2008, 4 months prior to separation, the CI reported weakness in the low back with repetitive motion.  He stated he was able to flex forward with no problem, but had difficulty with returning to an upright position due to weakness.  Physical examination showed thoracolumbar ROM, after repetition, measured flexion of 75 degrees (normal 90) and combined ROM of 225 degrees (normal 240),with painful motion.  

At the 30 April 2009 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported constant low back pain (6.5/10) that increased by the end of the day and intermittently radiated down the right leg to the calf area.  Physical examination showed normal gait and posture, without spasm or guarding; tenderness and painful motion were noted.  Thoracolumbar ROM showed flexion of 55 degrees after repetition, with combined ROM of 215 degrees.  Neurovascular examination was intact.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5243 (intervertebral disc syndrome), citing forward flexion of 78 degrees and combined ROM of 228 degrees with spasm and tenderness present.  The VA rated the low back condition 20%, coded 5237 (lumbosacral strain), based on the C&P examination, citing additional functional loss of motion on repetitive motion, with thoracolumbar flexion of 55 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 VA C&P examination.  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 low back condition, coded 5243.  

BOARD FINDINGS:  In the matter of the low back condition, the panel 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 the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Intervertebral Disc Syndrome, Lumbar Spine	5243	20%	

The following documentary evidence was considered:  

Exhibit A.  DD Form 294, dated 20170304, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Record  

AR20180007339, XXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

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