RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02179
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20081030

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Signal Support Systems Specialist, medically separated for “lumbar degenerative disc disease (DDD)” with a disability rating of 20%.  

CI CONTENTION:  His back continues to worsen and negatively impact daily activities.  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 - 20080625	VARD - 20090331	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar DDD 	5299-5242	20%	Thoracolumbar Spine Strain	5237	40%	20090225	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Lumbar DDD.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition began in September 2006 after wearing battle gear for a week during re-entry training (he had a prior tour of service that ended 4 years earlier).  No specific injury or trauma was reported.  X-rays in August 2007 showed straightening of the lumbar spine, well preserved intervertebral disc spaces, no signs of acute fracture, and were reported as consistent with muscle spasm.  An MRI in October 2007 revealed pseudoarticulation of the transverse process of L5 with the sacrum, possible conjoined nerve roots at L5-S1 on the left side, and disc height reduction at L5-S1 with no significant spinal canal stenosis or foraminal narrowing.  It was determined the CI was not a surgical candidate.

At a 20 February 2008 physical therapy (PT) session, 8 months before separation, the therapist recorded tenderness, mild loss of lumbar lordosis, and painful but full lumbosacral range of motion (ROM), noting the CI related that “today is a good day.”  ROM measurements at the PT session on 12 March 2008, 8 months before separation, showed flexion of 40 degrees (normal 90) and combined ROM of 140 (normal 240), with painful motion recorded.  Thoracolumbar ROM measurements taken by PT on 8 April 2008 showed flexion of 55 degrees (normal 90) and combined ROM of 145 (normal 240) after repetition.  

The 30 April 2008 MEB NARSUM examination, 6 months prior to separation, noted complaints of back pain that increased with prolonged standing, running, and sit-ups.  He denied radiation of pain into the lower extremities.  Physical examination revealed a normal gait and spinal contour with mild tenderness but no spasm or guarding.  The examiner listed the PT measurements taken on 8 April 2008, 7 months prior to separation, indicating ROM was limited by pain but not by weakness, fatigue, lack of endurance, or incoordination.  At the 24 June 2008 primary care appointment, 4 months prior to separation, the examiner documented lumbosacral tenderness and spasm with a normal gait and spinal contour.  Active flexion and extension were recorded as decreased but specific measurements were not provided.  

At the 25 February 2009 VA Compensation and Pension (C&P) orthopedic examination, 4 months after separation, the CI reported intermittent low back pain without radiation.  The pain flared in the mornings, sometimes reaching 8/10 in intensity, and was worsened on exposure to cold weather, prolonged sitting, stair climbing, and stooping.  He was taking one Motrin tablet as needed, was using a back corset, and indicated the pain did not interfere with his activities of daily living.  He denied any incapacitating episodes.  The examiner found a normal gait and spinal contour, slight tenderness, and no muscle spasm.  ROM was 30 degrees of flexion and combined ROM of 125 degrees after repetition, with painful motion noted.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 20%, analogously coded 5299-5242 (degenerative arthritis of the spine), citing forward flexion of 55, 60, and 55 degrees.  The VA rated the back condition 40%, coded 5237 (lumbosacral strain), based on the C&P examination, citing flexion of 0-30 degrees.  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 reported on the March and April 2008 PT examinations (and the MEB NARSUM) proximate to separation.  There was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula. 

Panel members noted that the limitation of thoracolumbar flexion reported in the C&P examination suggested consideration of the next higher rating of 40%.  In assigning probative value to these conflicting examinations, the panel noted the ROM values reported by the VA examiner 4 months after separation were significantly worse than those reported by the PT/MEB examiners (6-8 months before separation), and were inconsistent with other observations at the C&P examination (normal gait/contour, slight tenderness, no spasm).  There was no record of recurrent injury or other development in explanation of the more marked impairment reflected by the VA ROM measurements.  While ROM limitations may have progressed over time, there was no evidence in the record from which to conclude that the severity at separation approached that portrayed by the VA measurements.  Members noted that three separate ROM measurements prior to separation warranted a rating of 20% or lower, and agreed that these examinations were more consistent with the STR and more reflective of the anticipated severity based on the clinical pathology.  The panel therefore relied more heavily on the NARSUM/PT examination measurements.  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.  
BOARD FINDINGS:  In the matter of the lumbar degenerative disc disease 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 20170403, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180015064, 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