RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-02528
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090520

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 from the Temporary Disability Retired List (TDRL) for “posttraumatic stress disorder (PTSD)” and “lumbar spinal fusion,” rated 10% each, with a combined disability rating of 20%.   

CI CONTENTION:  Review all conditions.  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 - 20090407	VARD - 20080506	
Condition	Code	Rating	Condition	Code	Rating	Exam	
PTSD	9411	10%	PTSD	9411	50%	20071228	
Lumbar Spinal Fusion	5241	10%	Degenerative Arthritis, Thoracolumbar Spine 	5242	10%	20071220	
Right Shoulder Sprain	Not Compensable	No VA Placement	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

PTSD.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI was first seen by a mental health (MH) provider in September 2007 because he felt overwhelmed with "everything."  At the time of TDRL placement, the CI reported feeling okay in the mornings, but by afternoon, he was feeling “down.”  He had a history of having depressed mood, decreased concentration and insomnia with bad dreams, for which he took medications that “helped,” but were only partially effective.
During the 18 February 2009 MEB NARSUM examination, 3 months prior to TDRL removal, the CI reported no history of psychiatric hospitalizations, suicidal attempts, or violent behaviors.  He enjoyed his full-time job as a correctional officer and lived with his wife and three children and liked spending time with them.  The mental status examination (MSE) was unremarkable with the exception of a self-reported “up and down” mood.  The psychiatrist noted the CI’s symptoms were managed with medications.
 
The STR demonstrated continued stability of symptoms over 2 years of employment as a correctional officer, and a psychology encounter on 29 December 2009, 7 months after TDRL removal, noted an unremarkable MSE.  The CI reported being frustrated with his job and had applied for a patrol job, but was still awaiting a decision.  He reported minimal change in sleep and nightmare frequency, or intensity or duration, but noted his Christmas was “pretty good.”  He also stated his medication had been effective.  

During the 11 March 2010 psychology visit, the CI reported additional stress and tension with his wife after their son and his girlfriend moved into their home.  He acknowledged that shift work had contributed to sleep problems, but was not interested in making a shift change because of close relationships with co-workers who were “kinda like family.”  

At the 26 April 2010 psychology session, 11 months after TDRL removal, the CI reported being happy while working on the installation of an above ground pool at his home, but his marital distress and insomnia had increased.  He had significant insomnia related to stressors from work when an inmate who had recently left the jail made repeated threats against the CI and his family.  He was fearful for his family but was reluctant to report the situation.  The therapist noted that most of his sleep problems were related to excessive worry, shift work and stress.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated PTSD 10%, coded 9411 (PTSD), citing continuous medications to control symptoms.  The VA rated PTSD 50%, coded 9411, based on the C&P examination 17 months prior to TDRL removal, citing “a mental disorder that developed in service as a result of a highly stressful event, and was severe enough to bring about the veteran's release from active military service, the rating agency shall assign an evaluation of not less than 50 percent.”

The panel considered the absence of emergency room treatment or hospitalizations, and the apparent stability of symptoms during the 14 months prior to TDRL removal and the 11 months after TDRL removal.  The CI was able to maintain employment in the same job for more than 2 years, with no record of missed work, and no indication of occupational impairment, lack of concentration, workplace violence or falling asleep on the job due to MH symptoms.  He had a good relationship with his wife and children despite some tension, and enjoyed doing work around the house, and he had close connections with his co-workers.  Members agreed that a 10% rating, but no higher, was justified for “occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication.”  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 MH disorder.

Lumbar Spinal Fusion.  According to the STR and MEB NARSUM, the CI’s back condition began in June 2004 after lifting an oversized tire.  A surgical fixation of the lumbar spine was performed in September 2006 without complications.  During the 18 February 2009 orthopedic MEB NARSUM examination, 3 months prior to TDRL removal, the CI complained of constant pain over the lower back.  Physical examination showed normal appearing alignment of the spine and a slightly antalgic gait, but he was able to heel and toe walk.  There was tenderness over the lumbar area, but no evidence of spasm.  Lower extremity motor strength, sensory function and reflexes were intact.   Range of motion (ROM) testing showed 30 degrees of flexion.  However, the physical therapy goniometric ROM study showed 80 degrees of flexion and combined ROM of 195 degrees, with no change in ROM after three repetitions.

The 20 December 2007 C&P examination, 17 months prior to TDRL removal, recorded 90 degrees of flexion and 185 degrees of combined thoracolumbar ROM.  There were no subsequent ROM measurements in the STR.

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 limitation of forward flexion.  The VA also rated the back condition 10%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing combined ROM of 185 degrees with pain after repetitive use.  Members agreed that a 10% rating, but no higher, was justified for limitation of combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the VA C&P and MEB PT examinations.  The panel considered the 30-degree flexion measurement in the NARSUM an outlier because it was recorded 3 minutes after the PT ROM examination, and was likely recorded in error.  There was no muscle spasm or guarding severe enough to result 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.  

Contended Condition:  Right Shoulder Sprain.  The right shoulder condition was a new diagnosis that was found unfitting by the PEB, but was non-compensable because it was neither caused by nor directly related to the treatment of the conditions for which the CI was placed on the TDRL; nor was it an unfitting condition at the time of TDRL placement.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB compensability determination for contended condition, so no additional disability rating is recommended.    

BOARD FINDINGS:  In the matter of the MH condition and IAW VASRD §4.130, the panel recommends no change in the PEB adjudication.  In the matter of the back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended right shoulder condition, the panel agrees it cannot recommend it for additional disability rating.  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 20170316, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190007838, 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.