RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02792
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090604

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Signal Support System Specialist, medically separated for “intervertebral disc syndrome, L4-5 with large central disc protrusion” with a disability rating of 10%.  

CI CONTENTION:  “I experience chronic pain on a daily basis and it is getting worse.”  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 - 20090218	VARD - 20100119	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Intervertebral Disc Syndrome …	5243	10%	Thoracic Spine Tendonitis and Degenerative Arthritis of Lumbar Spine with Herniated Disc L4-L5	5242	10%	20090819	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Intervertebral Disc Syndrome (IVDS).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s lower back condition began in 2006 after a parachute jump.  Initial evaluation and X-rays were negative, but a lumbar MRI in April 2008 showed multilevel degenerative disc disease and central disc bulges at L4-5 and L5-S1 with facet arthropathy, and foraminal and spinal canal narrowing.  During the 12 November 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, physical examination revealed decreased forward flexion, tenderness, and lumbar spine flattening.  The 8 January 2009 MEB NARSUM examination, 5 months before separation, noted CI complaints of chronic daily pain, rated at 4-5/10, and increased to 7-9/10 with activity.  Physical examination showed a normal gait, but mild flattening of the lower lumbar spine with spasm and tenderness.  Goniometric ROM measurements showed flexion of 70 degrees and combined ROM of 175 after three repetitions and with discomfort.  

At the 19 August 2009 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported low back stiffness, spasms, decreased motion and numbness.  Physical examination showed posture and gait “within normal limits,” and no guarding or muscle spasms; however, tenderness was present.  Thoracolumbar ROM measurements showed flexion of 90 degrees and combined ROM of 240 degrees after repetition and with pain.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5243 (IVDS), citing limitation of motion with forward flexion of 65 degrees and combined ROM of 170 degrees.  The VA also rated the low back condition 10%, but coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing localized tenderness.  Panel 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 combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the NARSUM examination.  The VA examination also supported a 10% rating for the presence of tenderness.  Although there was muscle spasm, it was not severe enough to result in an abnormal gait or spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis, thus the next higher 20% rating was not justified on this basis.  There was no evidence of IVDS which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration under that alternate 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 low back condition.  

BOARD FINDINGS:  In the matter of the low back condition 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 20170421, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190007097, 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.