RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01445
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090425

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E5, Heavy Construction Equipment Operator, medically separated for “lumbar degenerative disc syndrome and spondylosis” and “cervical degenerative disc syndrome and spondylosis,” rated 10% each, with a combined disability rating of 20%.  

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 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 - 20090120	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar Degenerative Disc Syndrome 	5243	10%	No VA Examination Proximate to Separation in Evidence	
Cervical Degenerative Disc Syndrome	5243	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  NA 	

ANALYSIS SUMMARY:  

Lumbar Degenerative Disc Syndrome.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition began during his deployment in 2004-2005 without specific injury or trauma.  Radiographic studies in November 2007 were normal, but an MRI in November 2007 showed a central disc bulge at L4-5 and disc herniation at L5-S1 with narrowing of the left lateral recess.  At a fitness for duty evaluation by orthopedics on 26 December 2007, the physical examination showed normal thoracolumbar range of motion (ROM) with tenderness in the L5 area.  There was no muscle spasm and straight leg raise testing was negative for radiculopathy.  The CI had a normal gait, normal strength in the lower extremities, and normal reflexes.  

The 10 July 2008 MEB NARSUM examination, 10 months prior to separation, noted complaints of low back pain.  Physical examination noted mild tenderness and spasm in the right paraspinal muscles, but there was no guarding.  The CI had full ROM, but it was painful, and there was no decrease with repetitive motion.  The CI had normal strength in his lower extremities with a slight decrease during knee extension.  There were normal reflexes and tandem walk, and the CI could heel and toe walk.  The examiner opined “pain could significantly limit functional ability during a flare up; however, quantifying this additional limitation would be sheer speculation.”  

At the 20 August 2008 physical therapy (PT) MEB ROM study, 8 months prior to separation, the CI reported 7/10 back pain.  ROM measurements, after repetition, showed flexion of 75 degrees (normal 90) and combined ROM of 185 degrees (normal 240).  There was no VA examination proximate to separation.  The panel considers 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.  

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 flexion of 80 degrees without neurologic abnormality.  The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion greater than 60 degrees but not greater than 85 degrees, and combined ROM greater than 120 degrees but not greater than 235 degrees, as reported on the PT examination proximate to separation.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  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 back condition.  

Cervical Degenerative Disc Syndrome.  According to the STR and the MEB NARSUM, the CI’s neck condition also began during his deployment in 2004-2005 without evidence of injury or trauma.  Radiographic studies in November 2007 were normal.  At the fitness for duty evaluation on 26 December 2007, the CI had a normal pain-free ROM of his cervical spine.  Tenderness was present, but there were no muscle spasms.  

The MEB NARSUM examination noted complaints of neck pain.  Physical examination showed mild tenderness and a “virtually normal” ROM.  ROM measurements did not decrease with repetitive motion; however, pain increased.  The CI had normal strength in his upper extremities and normal reflexes.  At the PT MEB ROM study the CI reported 4/10 neck pain.  ROM measurements, after repetition, showed flexion of 40 degrees (normal 45) and combined ROM of 285 degrees (normal 340).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 10%, coded 5243, citing combined cervical ROM of 305 degrees without neurologic abnormality.  The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion greater than 30 degrees but not greater than 40 degrees, and combined ROM greater than 170 degrees but not greater than 335 degrees, as reported on the PT ROM examination.  There was no muscle spasm or guarding severe enough to result in an abnormal spinal contour, thus the next higher 20% rating was not justified on this basis.  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 neck condition.  

BOARD FINDINGS:  In the matter of the back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the neck condition and IAW VASRD §4.71a, 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 20170228, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180007884, 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