RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02901
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050208

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Intelligence Analyst, medically separated for “chronic back pain due to L5-S1 spondylolisthesis with degenerative disc disease [DDD]” with a disability rating of 10%.  

CI CONTENTION:  She should have been medically retired for her disability and had multiple other conditions rated by the VA and not the Army.  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 - 20041207	VARD - 20050503	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain…	5239	10%	Spondylosis and Spondylolisthesis, Lumbar Spine	5239-5242	10%	STR	
DDD, C5-C6	Not Unfitting	DDD, Cervical Spine	5242-5243	10%	STR	
Anal Fissures	Not Unfitting	Hemorrhoids	7339	0%	STR	
Migraine Headaches	Not Unfitting	Migraine Headaches	8100	0%	STR	
Bilateral Bunionectomies	Not Unfitting	Right Foot Bunionectomies	5280	0%	STR	
		Left Foot Bunionectomies	5280	0%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Back Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition began in March 1998 with no history of trauma or inciting event.  X-rays showed lumbosacral spondylolisthesis and spondylolysis, as well as DDD at L5-S1.  Increasing back pain through 2004 led to specialty evaluations indicating similar MRI findings in July 2004, and no surgical options.  

Multiple chiropractic and physical therapy (PT) evaluations from July 2004 through October 2004 documented either painful back motion, tenderness, or spasms without formal range of motion (ROM) measurements.  The 2 November 2004 MEB NARSUM examination, 3 months prior to separation, noted complaints of chronic low back pain.  Physical examination referred to PT active ROM measurements with flexion of 85 degrees (normal 90) and combined ROM of 195 degrees (normal 240).  Straight leg raising caused pain and hip motion was limited due to pain.  There was no VA examination proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5239 (spondylolisthesis), citing combined thoracolumbar ROM [passive].  The VA rated the back condition 10%, dual coded 5239-5242 (spondylolisthesis-degenerative arthritis of the spine), based on the STR, citing combined ROM.  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 examination.  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 (IVDS) with incapacitating episodes which would provide for a higher rating under that formula.  After due deliberation, considering all of 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 chronic back pain condition.

Contended PEB Condition:  DDD, C5-C6.  The panel’s main charge is to assess the fairness of the PEB determination that the contended neck condition was not unfitting.  The cervical spine condition was judged to fail retention standards, but was not specifically profiled or implicated in the commander’s statement.  

The CI was referred to the chiropractic clinic in March 2004 for spinal manipulation of the cervical spine (and lumbar spine).  October 2002 and July 2004 MRIs showed degenerative disk changes with a prominent bulging at C5-C6.  Almost all STR entries for the unfitting back condition also noted neck tenderness, pain, or painful motion.  Chiropractic evaluation on 20 September 2004 indicated that neck pain (7/10) was rated higher than back pain (4/10), and five prior evaluations also documented cervical segment dysfunction.  During the 13 September 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported neck pain.  Physical examination revealed pain with cervical flexion and extension as well as crepitus.  At the 1 December 2004 MEB PT evaluation, neck ROM was flexion to 35 degrees (normal 45) and combined ROM was 290 degrees (normal 340).

Given the performance limitations attributable to the back condition (general P3 profile), specifically including lifting restrictions, members noted there was significant overlap with limitations from the neck condition, and both MEB NARSUM and MEB proceedings determined the C5-C6 DDD was medically unacceptable.  The panel agreed that the preponderance of performance-based evidence showed the neck condition as an additionally unfitting condition.  Members agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 40 degrees) and/or combined ROM (greater than 170 degrees but not greater than 335 degrees), as reported on the MEB PT evaluation and was supported by painful motion on the MEB examination.  Although there was STR evidence of muscle spasm, it was not 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 IVDS with incapacitating episodes which would provide for a higher rating under that formula.  After due deliberation, the panel agreed the preponderance of the evidence with regard to the functional impairment of the neck condition favors its recommendation as an additionally unfitting condition for disability rating.  It is appropriately coded 5242 and meets the VASRD §4.71a criteria for a 10% rating.  

Other Contended PEB Conditions:  Anal Fissures, Migraine Headaches, and Bilateral Bunionectomies.  The panel’s main charge is to assess the fairness of the PEB determination that the other contended conditions were not unfitting.  None of the conditions were profiled, implicated in the commander’s statement, or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions 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 any of the other contended conditions, so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the chronic back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended degenerative disc disease C5-C6 condition, the panel agrees it was unfitting and recommends a disability rating of 10%, coded 5242 IAW VASRD §4.71a.  In the matter of the contended anal fissures, migraine headaches, and bilateral bunionectomies conditions, the panel recommends no change from the PEB determinations 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	
Chronic Back Pain due to L5-S1 Spondylolisthesis with Degenerative Disc Disease	5239	10%	
Degenerative Disc Disease, C5-C6	5242	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170426, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180008793, XXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

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 

Sincerely,					      
Enclosure