[AR Number], XXXXXXXXXX

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XXXXXXXXXX
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Dear XXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs and to the counsel you listed on your application; [name and address].

Sincerely,		

			      
Enclosure

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-02259
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071221

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Infantryman, medically separated for “lumbar degenerative disc disease [DDD]” with a disability rating of 0%.  

CI CONTENTION:  He was given a higher rating by the VA for the back condition and the VA rated posttraumatic stress disorder (PTSD) 50%, but it was not included in the Medical Evaluation Board (MEB).  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 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 - 20071128	VARD - 20081104	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar DDD	5299-5242	0%	Degenerative Arthritis of the Lumbar Spine	5242	20%	20081002	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  70% 	

ANALYSIS SUMMARY:  

Lumbar DDD.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in 2003 while deployed.  He experienced bouts of mild pain and stiffness with his back whenever he had to wear armor and other gear.  He served the rest of the deployment and a subsequent deployment without any serious problems.  In July 2007, while he was running, he felt his back muscles tighten to the point he could no longer run.  Shortly thereafter when he landed from rappelling he felt a sharp pain up his back.  X-rays showed spondylosis at L3 and an MRI demonstrated multilevel spondylitic (degenerative) changes in the lumbar spine, which were mild in degree, but somewhat advanced for the CI’s age.  There was also bilateral pars interarticularis defects demonstrated at L3 without any evidence of associated spondylolisthesis (one vertebra sliding over the vertebra below it).  

At the 9 August 2007 orthopedic appointment, 4 months prior to separation, the CI reported low back pain.  Physical examination showed a normal gait and stance.  There was tenderness, but no muscle spasm.  Thoracolumbar range of motion (ROM) testing was normal in all planes of motion.

The 14 November 2007 MEB NARSUM examination, one month prior to separation, noted complaints of constant but tolerable back pain, which was exacerbated by activity.  Physical examination showed normal heel and tandem walking.  Toe walking was equivocal due to ankle problems.  There was no spasm, guarding or tenderness.  Thoracolumbar lumbar ROM measurements were flexion of 60 degrees (normal 90), limited by pain, and combined ROM of 190 degrees (normal 240).  An inclinometer was used to assess forward flexion, extension and lateral flexion measurements, and a goniometer was used to assess rotation measurements.  Lower extremity strength was normal and straight leg raise testing (to determine nerve root irritation) was negative bilaterally.  

At the 2 October 2008 VA Compensation and Pension (C&P) examination, 10 months after separation, the CI reported low back pain.  Physical examination showed tenderness, but no spasm.  Bilateral straight leg raise testing was negative.  The ROM evaluation showed forward flexion of 60 degrees and combined ROM of 210 degrees with pain.  The joint function of the spine was not further limited by pain, fatigue, weakness, lack of endurance or incoordination after repetitive use.  Inspection of the spine revealed normal head position with symmetry in appearance.  X-rays of the thoracic spine on 2 October 2008 were normal, while X-rays of the lumbar spine showed minimal diffuse spondylosis of the various segments along with mild disc space narrowing of L4-5.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 0%, analogously coded 5299-5242 (degenerative arthritis of the spine), citing ROM limited by pain.  The VA rated the back condition 20%, analogously coded 5299-5242 (degenerative arthritis of the spine), based on the C&P examination, citing forward flexion of 60 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 MEB NARSUM and VA examinations.  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 recommends a disability rating of 20% for the back condition, coded 5242.  

Contended PEB Condition:  Anxiety Disorder.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement or judged to fail retention standards.
The MEB psychiatric addendum, dated 14 November 2007, noted the CI’s behavioral health condition was clinically stable and did not require inclusion in the MEB, since it met retention standards for the Army.  Although a post-separation VA mental health consultant noted the CI had anxiety symptoms related to combat experiences and diagnosed him with PTSD, the CI maintained steady employment and deferred mental health treatment based on his work schedule.  The panel could find no performance-based evidence from the record to show how the mental health disorder 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 contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the lumbar degenerative disc disease, the panel recommends a disability rating of 20%, coded 5242 IAW VASRD §4.71a.  In the matter of the contended anxiety disorder, the panel recommends no change from the PEB determination 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, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Lumbar Degenerative Disc Disease	5242	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170225, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record