RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01716
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060622

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E6, Food Service Operations Specialist, medically separated for “chronic back pain, due to lumbar degenerative disc disease” with a disability rating of 0%.   

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 - 20060509	VARD – 20060823 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain, due To Lumbar DDD…	5299-5242	0%	DDD of Lumbar Spine, at L4-L5 and L5-S1	5242	10%	20060627	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:  

Chronic Back Pain, due to Lumbar Degenerative Disc Disease (DDD).  According to the service treatment record and MEB narrative summary (NARSUM), the CI first experienced low back pain in 1987 while on active duty status without injury or trauma.  She continued to have intermittent low back pain until December 2004 when she was loading vehicles onto a railcar and fell off the railhead landing on her back.  She was able to complete her deployment after the fall.  A bone scan was interpreted as normal.  X-rays of the lumbar spine revealed narrowing and minimal spurring at the L5-S1 read as mild degenerative changes.  An MRI of the lumbar spine showed mild spinal canal stenosis, mild left and right foraminal stenosis, and DDD from L2-3 through L5-S1.  Electrodiagnostic studies were reported as normal without evidence of radiculopathy.  
The 18 February 2005 primary care visit, 16 months prior to separation, noted full range of motion (ROM) but the CI began to cry as she performed ROM movements.  The 24 January 2006 medical holdover clinic visit, 5 months prior to separation, noted tenderness in the left paraspinal area of the mid-thoracic region.  The 1 February 2006 outpatient rehabilitation clinic note, 4 months prior to separation, recorded tender points in the low back.  The 7 April 2006 medical holdover clinic note, 2 months prior to separation, reported normal motion of the lumbar spine, no muscle spasms, and a normal gait and posture.  Tenderness and painful motion were noted.  

The 19 April 2006 MEB NARSUM examination, 2 months prior to separation, noted complaints of inability to perform activities such as lifting and carrying heavy cooking pots.  She was unable to ruck march, dig a firing position, set up nets and tents, or perform activities involving running, jumping, and sit-ups.  Physical examination showed no muscle spasm or guarding and gait was normal.  Thoracolumbar ROM measurements performed by physical therapy showed flexion of 130 degrees (normal 90) and combined ROM in excess of 240 degrees (normal 240) with each measurement well above normal.  

At the 27 June 2006 VA Compensation and Pension (C&P) examination, 1 week after separation, the CI reported constant aching localized pain that was elicited by physical activity.  The examiner found no tenderness, muscle spasm, or guarding, and gait and spinal contour were normal.  Thoracolumbar ROM showed flexion to 78 degrees (normal 90) and combined ROM of 210 degrees (normal 240).  There was no additional limitation with repetitive motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the lumbar spine DDD condition 0%, coded 5099-5242 (analogous to degenerative arthritis of the spine), citing combined thoracolumbar ROM greater than 240 degrees.  The VA rated the lumbar spine DDD condition 10%, also coded 5242, based on the C&P examination, citing forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees.  

Of the examinations proximate to separation there was only one examination which displayed limitation of thoracolumbar spine motion to support a 10% rating under the General Rating Formula for Diseases and Injuries of the Spine.  However, the propensity of evaluations proximate to separation did note the presence of painful motion or localized tenderness to support a 10% rating.  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.  There was no documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes which would provide for a higher rating under that formula (for IVDS).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the lumbar spine DDD condition, coded 5242.  

BOARD FINDINGS:  In the matter of the lumbar spine DDD condition, the panel recommends a disability rating of 10%, coded 5242 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Back Pain, Due To Lumbar DDD…	5242	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170327, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180005415, 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