RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02288
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080807

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Cannon Crewmember, medically separated for “degenerative arthritis, lumbar spine” with a disability rating of 10%.  

CI CONTENTION:  Review requested of back condition as well as additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 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 - 20080728	VARD - 20080828	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Arthritis, Lumbar Spine	5242	10%	Disc Bulge, Thoracolumbar Spine	5242	10%	20080708	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Lumbar Spine Degenerative Arthritis.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in July 2006 without specific trauma.  Spine X-rays were negative, but an MRI showed disc bulges at L4-5 and L5-S1 with mild spinal canal narrowing.  A clinic visit on 8 May 2008 revealed lumbosacral spine tenderness and active flexion reduced by about 50%; thoracic spine X-rays showed minimal scoliosis (3 degrees).  During the 22 May 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported lower back problems that caused severe pain.  The examiner documented a normal gait and discomfort in all planes of thoracolumbar range of motion (ROM), with flexion of 85 degrees (normal 90) and combined ROM of 225 degrees (normal 240).  

The 2 July 2008 MEB NARSUM examination, 1 month before separation, noted CI complaints of daily low back pain with an average intensity of 4-5/10 and flare-ups reaching 9-10/10.  The flare-ups lasted approximately 5-6 hours, occurred 1-2 times per month, and were directly related to running or lifting activities.  He was able to walk, but did experience some discomfort with prolonged walking.  Physical examination revealed tenderness, but no abnormal spinal contour, muscle atrophy or spasm, or radicular signs.  Muscle strength and coordination were good and he was able to heel and toe walk.  Thoracolumbar ROM testing showed flexion of 70 degrees, with pain, and combined ROM of 210 degrees, with discomfort after repetition.  No mechanical restriction, fatigue, lack of endurance, muscle weakness or incoordination was noted. 

At the 8 July 2008 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported stiffness and constant pain in the low back.  The pain was characterized as burning, aching and sharp with a pain level of 8/10, and exacerbated by physical activity; however, he denied incapacitation.  Physical examination showed no radiating pain, muscle spasm or tenderness, and straight leg raise testing (to determine nerve root irritation) was negative bilaterally.  There was no ankylosis of the lumbar spine, and thoracolumbar ROM testing showed flexion of 65 degrees and combined ROM of 165 degrees with pain at end ranges.   Lumbar spine X-rays showed mild degenerative disc space narrowing at L4-5.  

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 limitation of motion.  The VA also rated the back condition 10%, coded 5242, based on the C&P examination, citing limitation of forward flexion.  Members agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) and/or combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the MEB NARSUM and VA examinations proximate to separation.  There was no evidence of muscle spasm or guarding resulting in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  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 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 spine degenerative arthritis 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 20170123, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190007811, 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