RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01892
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20081114

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Motor Transport Operator, medically separated for “degenerative arthritis of the lumbar spine” with a disability rating of 10%.

CI CONTENTION:  Condition continues to worsen.  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 - 20080829	VARD - 20090605	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Arthritis of the Lumbar Spine	5242	10%	Lumbarsacral Strain 	5242	10%	20090515	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Degenerative Arthritis of the Lumbar Spine.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back pain (LBP) began in June 2005 after trying to lift a heavy tire while deployed to Iraq.  She continued to have LBP throughout the deployment and a subsequent overseas tour with worsening in early 2007.  A September 2007 X-ray showed decreased L5-S1 disc space with arthritic changes involving spine facet (vertebrae) joints.  The 9 October 2007 MRI revealed L4-L5 and L5-S1 disc protrusions (bulge under pressure).  The July 2008 electromyogram of the lower extremities was normal (test for nerve weakness and numbness).  Surgery was not indicated.  

At the 12 May 2008 VA Compensation and Pension (C&P) evaluation, 6 months before separation, the CI reported LBP and numbness aggravated by exercise and prolonged sitting or standing.  Physical examination showed a normal gait and posture without spinal tenderness or muscle spasm.  Range of motion (ROM) was “full” without pain.  

MEB ROM testing was performed by physical therapy on 14 May 2008.  Flexion was 90 degrees (normal) and combined ROM was 235 degrees (normal 240); painful motion was present.  The 17 June 2008 MEB NARSUM examination, 5 months prior to separation, noted complaints of constant LBP aggravated by standing up straight or prolonged driving.  There was occasional tingling and numbness down the inner-left thigh to the inner foot.  Physical examination showed normal gait and stance with spinal tenderness, but no muscle spasm.  

During the 15 May 2009 C&P evaluation, 5 months after separation, the CI reported nagging LBP with flare-ups that occurred every 2 to 3 weeks and lasted 1 to 2 days.  She denied incapacitating episodes within the past 12 months.  Physical examination showed a normal gait and posture without spinal tenderness, muscle spasm or guarding.  Repetitive-thoracolumbar ROM was flexion of 70 degrees and combined ROM of 190 degrees; painful motion was elicited.

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 spinal tenderness.  The VA also rated the back condition 10%, coded 5242, based on the C&P examination 5 months after separation, citing painful motion.  The panel agreed that a 10% rating, but no higher, was justified for limitation of combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the MEB ROM and post-separation VA examinations.  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 evidence of intervertebral disc syndrome which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula for that condition.  After due deliberation, considering all of 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 of the back condition.

BOARD FINDINGS:  In the matter of the back 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 20170325, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180005854, 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