RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXX	CASE: PD-2017-02100
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20090225

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, M1 Armor Crewman, medically separated for “intervertebral disc syndrome (IVDS)” with a disability rating of 20%.

CI CONTENTION: The VA gave me a 70% rating to include 40% for lumbar spine degenerative disc disease (DDD), 20% for left lower extremity radiculopathy, and 30% for adjustment disorder with mixed anxiety and depressed mood.  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 - 20090113	VARD - 20090422	
Condition	Code	Rating	Condition	Code	Rating	Exam	
IVDS	5243	20%	Lumbosacral DDD	5243	10%	20090114	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

IVDS. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI first experienced an onset of low back pain from a strain injury in January 2007 that was exacerbated by another strain injury a year later. Imaging (MRI) demonstrated degenerative changes with disc disease (protrusion L5/S1 with “mild” left neuroforaminal narrowing). The back pain was associated with intermittent left lower extremity (LLE) sensory findings (L5/S1 dermatome), but no subjective motor complaints. Multiple neurological examinations were normal (motor, sensory, reflexes); electrodiagnostic testing (EMG) was normal; and, surgery was

not recommended. Provider entries in the STR documented grossly normal to non-specifically limited range of motion (ROM), with some that approximated flexion in the 60-70% range (normal 90), and none that indicated any more significant ROM limitation. There was STR documentation of a normal gait and normal spinal contour, with no contrary entries, and there was no documentation of incapacitating episodes.

A physical therapy (PT) examination on 1 December 2008, 3 months before separation, noted complaints of low back pain that sometimes encompassed the entire back. Physical examination revealed normal a curvature. Lumbar spine flexion was fingertips to the proximate (top) of the shins or approximately 45 to 60 degrees (normal 90), and combined range of motion (ROM) was incomplete. Painful motion was not addressed. The MEB NARSUM examination, 8 days later, noted complaints of intervertebral disc degeneration. Physical examination showed a slightly stiff and antalgic gait. There was no back trauma, spinal tenderness was present and muscle spasm was absent. There was limited flexion and extension secondary to pain. The same-day MEB PT examination noted back pain between achy and throbbing. Physical examination showed repetitive, goniometric measured flexion to 55 degrees and combined ROM was 160 degrees (normal 240). Pain-limited motion was elicited. There was no additional ROM limitation with repetitive motion.

During the 11 July 2005 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported sharp low back pain. Physical examination showed a normal gait, poor posture, and spinal tenderness was present but muscle spasm was absent. Thoracolumbar spine flexion was 75 degrees and combined ROM was 200 degrees. Painful motion was elicited. There was no additional ROM limitation with repetitive motion.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the low back condition 20%, coded 5243 (IVDS), citing limitation of flexion to 55 degrees. Using the same code, the VA rated the low back condition 10% based on the C&P examination, citing limitation of flexion and combined ROM.

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 recorded on the PT and MEB PT examinations most proximate to separation. There was no documentation of IVDS with incapacitating episodes to support a higher rating under that formula, and there were no other ratable criteria in evidence that would support a higher rating. 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 low back condition.

The panel also considered if additional rating was justified for peripheral nerve impairment due to the LLE radiculopathy. While the CI may have suffered additional pain from nerve involvement, this is subsumed under the VASRD §4.71a general spine rating criteria that specifically states “with or without symptoms such as pain (whether or not it radiates).” There was no evidence for any significant objective sensory motor deficit (corroborated by EMG) that would have imposed any functional limitation in addition to pain. The panel thus agreed that additional rating for an associated spinal radiculopathy was not justified.

BOARD FINDINGS: In the matter of the intervertebral disc syndrome 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 20170308, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

	PD-2017-02100

AR20190012276, XXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXX

	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