RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02118
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061116

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty O-3, Quartermaster, medically separated for “chronic back pain, status post (S/P) L4-5 fusion with prior L1-2 laminectomy” with a disability rating of 10%.  

CI CONTENTION:  “Review all conditions.  Please review without significant neurologic abnormality and thoracolumbar range of motion.”  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 - 20060727	VARD - 20061211	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain, S/P L4-5 Fusion with Prior L1-2 Laminectomy	5241	10%	Surgical Residuals Lumbar Spine	5243	40%	20061012	
Hyperthyroidism/Graves Disease	Not Unfitting	Graves Disease	7999-7900	0%	20061012	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Chronic Back Pain, S/P L4-5 Fusion with Prior L1-2 Laminectomy.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in early 2003.  The CI had a history of low back pain (LBP) since January 1999 after falling off of a tank.  However, the CI’s LBP worsened in early 2003 and in October 2003 he presented with LBP, left lower extremity (LLE) pain, swelling of both LEs, and urinary retention.  He underwent surgery for removal of an intradural spinal cord tumor at L1-L2.  Following that surgery he continued to have LBP and LLE pain.  Electrodiagnostic studies were consistent with LLE S1 radiculopathy and a discogram was positive at L4-5; the CI underwent a second surgery on his back in November 2004 for L4-L5 laminectomy and fusion.  There was no change in the CI’s back and LLE pain following the surgery.  Lumbar spine MRI on 4 May 2005 showed no evidence of a recurrent tumor or any disc herniation or extrusion.  There was no spinal canal stenosis or neuroforaminal narrowing at any level.  A pain medicine examination on 7 November 2005 indicated the CI’s continued pain was likely due to scar tissue or degenerative spine changes.  Lumbar spine MRI on 3 January 2006 showed mild levoscoliosis, intact hardware and post-surgical changes from the two surgeries, mild degenerative facet changes at L5-S1 and well maintained disc heights without disc herniation.  Lumbar spine films in May 2006 showed intact hardware and anatomic alignment even with flexion and extension.  Pain medicine interventions did not significantly relieve the CI’s symptoms.  No further surgical intervention was indicated and he was treated with chronic narcotic pain medications.  

The 27 February 2006 MEB physical therapy examination, 9 months prior to separation, measured range of motion (ROM) and thoracolumbar flexion was 20 degrees (normal 90) and combined ROM was 95 degrees (normal 240) with severe pain noted with all movement.  During the 28 February 206 MEB examination (recorded on DD Forms 2807-1 and 2808) the following day, the CI reported continued LBP and LLE pain.  Physical examination showed a normal gait.  There was tenderness in the thoracic and lumbosacral spine with decreased ROM and pain elicited with ROM measurements and LLE motion.  There was LLE weakness with positive straight leg raise (SLR) testing on the left.  Motor strength was 4/5 and deep tendon reflexes were normal.  

The 17 April 2006 MEB NARSUM examination, 7 months prior to separation, noted complaints of significant LBP that kept the CI from being able to qualify with his assigned weapon, wear body armor or do physical exercise.  He could not stand or sit for any extended periods of time and he had difficulty concentrating due to pain.  He reported that he typically had 4-6 days per month when he could not function well enough to go to work.  He also reported he had great difficulties with his routine daily activities living at home.  Physical examination showed paraspinal muscle spasms and SLR caused back pain bilaterally.  Motor strength was 5/5, but weakness with toe raising was noted on the left and sensation was intact to light touch.  Reflexes were normal and there was no clonus.  The CI was not a surgical candidate at that time.  His final diagnoses were “degenerative disc disease of L4-5 S/P fusion” and “L1-2 laminectomy for removal of intradural tumor.”  

At the 12 October 2006 VA Compensation and Pension (C&P) examination, one month before separation, the CI reported constant pain, weakness, stiffness, fatigue, and lack of endurance of the lumbar spine.  Precipitating factors included physical activity and inclement weather.  Alleviating factors included rest and medication.  The CI also reported associated numbness and pain affecting his LLE extending to his foot which occurred once every 2 days lasting up to 2 hours.  His spine pain precluded his ability to walk extended distances.  He had not been placed on strict bed rest by a physician during the previous 12-month period.  Additional LE limitations included difficulty navigating stairs, walking and running long distances, or standing stationary or sitting for extended lengths of time.  The CI reported wearing a back brace that he considered helpful.  Physical examination showed an antalgic gait.  There was no change in ROM detected during repetitive movement or when resistance was applied to the lumbar spine.  There was no muscle atrophy noted and no postural abnormality.  There was a positive SLR.  Left great toe dorsiflexion strength was 3/5.  Sensation was intact.  There was tenderness noted over the lumbar vertebrae and paravertebral muscles bilaterally.  The CI’s thoracolumbar ROM was measured in degrees as   flexion15, extension 5, left lateral flexion 30, right lateral flexion 10, and 20 for both left and right rotation.  His combined ROM was 100 degrees.  Painful motion was noted in all measurements.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5241 (spinal fusion), citing pain-limited motion and localized tenderness.  The VA rated the back condition 40%, coded 5243 (intervertebral disc syndrome), based on the C&P examination, citing forward flexion of the thoracolumbar spine of 30 degrees or less.  

The panel agreed that a 40% rating was justified for limitation of flexion of 30 degrees or less as reported on the MEB PT and VA examinations.  There was no evidence of incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula for intervertebral disc syndrome.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 40% for the back condition, coded 5241.  

Contended PEB Condition:  Hyperthyroidism/Graves Disease.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The hyperthyroidism condition was profiled but not specifically implicated in the commander’s statement and did not fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the hyperthyroidism condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the back condition, the panel recommends a disability rating of 40%, coded 5241 IAW VASRD §4.71a.  In the matter of the contended hyperthyroidism/Graves disease condition, 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.  

The panel recommends the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Back Pain, S/P L4-5 Fusion with Prior L1-2 Laminectomy	5241	40%	

The following documentary evidence was considered:  

Exhibit A.  DD Form 294, dated 20170306, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Record  

AR20190007855, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 40% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557.

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,					       

Enclosure