RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01754
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080307

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Mental Health Specialist, medically separated for “lumbar spondylotic changes” with a disability rating of 10%.  

CI CONTENTION:  Review all conditions within the Service treatment history.  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:  

PEB - 20080221	VARD – NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar Spondylitis Changes 	5242	10%	No VA Examination Proximate to Separation in Evidence	
History Chronic Lipomas 	Not Unfitting		
Seasonal Allergies	Not Unfitting		
Headaches	Not Unfitting		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Lumbar Spondylitis Changes.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in July 2003 after five attempts to place a lumbar epidural catheter for pain control during labor.  After the removal of the epidural catheter, the CI reported pain at the catheter placement site for the next two months followed by back pain, spasm and swelling one or two times per month.  In September 2005, the CI was involved in a MVA where her vehicle flipped end-over-end multiple time before hitting a tree.  As a result of the accident, the CI reported increased back pain.  X-rays of the thoracic and lumbosacral spines were normal and a lumbar spine MRI in June 2007 showed minimal spondylotic changes from L3 to S1.  

At the 6 February 2006 family practice clinic examination, the CI complained of 6/10 back pain and spasms.  The examiner noted tenderness of the spinous process and full range of motion (ROM) of the lumbosacral spine without pain elicited by motion.  During the 5 September 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported no pain or spasm with palpation.  No bowel or bladder dysfunction was reported.  Physical examination revealed a normal gait.  There was full lumbar flexion, extension and rotation without pain, spasm or tenderness.  The MEB NARSUM, crafted the same day, noted complaints of low back pain with occasional spasm shooting down the left leg which was worse with running, high impact activities, axial loading, repetitive bending and twisting.  Physical examination was the same as recorded on the DD Form 2808.  The 2 October 2007 physical therapy ROM evaluation document forward flexion of 70 degrees (normal 90) and combined ROM of 185 degrees (normal 240) with painful 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 10%, coded 5242 (degenerative arthritis of the spine), citing flexion to 70 degrees and combined ROM of 194 degrees.  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/or combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the physical therapy examination proximate to separation.  There was no muscle spasm or guarding severe enough to result in an abnormal gait, thus the next higher 20% rating was not justified on this basis.  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 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.  

Contended PEB Conditions:  History of Chronic Lipomas, Seasonal Allergies and Headaches.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  The seasonal allergies and headaches were not profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the seasonal allergies or headaches conditions significantly interfered with satisfactory duty performance at separation.  The chronic lipomas were implicated in the commander’s statement who also noted prior profiles for that condition.  The CI underwent excisional biopsy of the largest right leg lipoma on 21 August 2007, and pathology reported “mature adipose tissue consistent with lipoma.”  There was no post-surgical complication noted.  The final profile did not list the lipoma condition, and lipomas of the anterior tibia were not judged to fail retention standards.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the back condition and IAW VASRD §4.71, the panel recommends no change in the PEB adjudication.  In the matter of the contended chronic lipomas, seasonal allergies and headaches, the panel recommends no change from the PEB determinations as not unfitting.  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.  

AR20190004100, XXXXXXXXXXXXXXXXXXXX

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Dear XXXXXXXXXXXXXXXXXXXX:

	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.