[AR Number], XXXXXXXXXX

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

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.

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-02950
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090429

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Wheeled Vehicle Mechanic, medically separated for “degenerative arthritis of the lumbar spine” and “bilateral sensorineural hearing loss,” rated 10% and 0%, respectively, with a combined disability rating of 10%. 

CI CONTENTION:  No specific contention was made.  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 - 20090122	VARD - 20091026 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Arthritis of the Lumbar Spine	5242	10%	DDD, Lumbar Spine	5242	10%	20090926	
Bilateral Sensorineural Hearing Loss	6100	0%	Sensorineural Hearing Loss	6100	NSC	20090928	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Degenerative Arthritis of the Lumbar Spine.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition began in November 2007 while in basic training.  Lumbar spine X-rays showed multilevel degenerative disc disease (DDD) and degenerative joint disease (DJD).  The CI was able to complete training, but had persistent pain.  An MRI on 24 July 2007 confirmed the DDD and DJD and noted a herniated disc at L4-5 with bilateral nerve root impingement.  

The 19 December 2008 MEB NARSUM examination, 4 months prior to separation, showed a slow, stiff gait with guarded transfers (change of position).  It was noted that the gait was abnormal due to guarding.  Tenderness was present, but spasm was not recorded.  The neurological evaluation was normal.  Range of motion (ROM) testing showed pain-limited flexion of 75 degrees (normal 90) and combined ROM of 185 degrees (normal 240).  

At the 26 September 2009 VA Compensation and Pension (C&P) evaluation, 5 months after separation, the CI reported ongoing low back pain with flares.  Incapacitation was not recorded.  Physical examination showed a slight limp, but it was not attributed to the back (or any other body part).  Neither spasm nor guarding was present.  The ROM study showed flexion of 90 degrees and combined ROM of 200 degrees, all limited by pain.  The neurological examination was normal.  

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 flexion.  The VA also rated the back condition 10%, coded 5242, based on the C&P examination, citing limitation of forward flexion.  The panel noted the limitation in motion supported a 10% rating, but the abnormal gait due to guarding supported a 20% rating.  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.  

Bilateral Sensorineural Hearing Loss.  According to the STR and MEB NARSUM, the CI was profiled with an H3 for hearing loss on 15 August 2008 by audiology.  A review of the record shows the following audiograms:

Right Ear Frequencies in Hertz (Hz)
Date	500	1000	2000	3000	4000	6000	Average*	Speech Discrimination	
19980424	10	10	0	15	25	10	12.5	---	
20070808
Accession	5	15	40	45	35	40	33.75	---	
Undated: MEPS	10	15	35	45	35	45	32.5	---	
20080925	5	20	40	45	35	55	35	---	
VA C&P
20090928	5	15	30	40	35	---	30	100%	

Left Ear Frequencies in Hz
Date	500	1000	2000	3000	4000	6000	Average 	Speech Discrimination	
19980424	5	5	0	40	35	15	20	---	
20070808
Accession	10	20	35	50	35	25	35	---	
Undated MEPS	10	15	35	35	40	30	31.25	---	
20080925	5	15	35	50	40	20 	35	---	
VA C&P
20090928	10	20	40	45	35	---	35	100%	

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the hearing loss 0%, coded 6100 (hearing impairment), citing a 100% word discrimination.  The VA determined the hearing loss to be non-service connected (NSC), coded 6100, noting 100% speech discrimination and essentially no change from accession physical.  The panel observed that regardless of which tables were used (VI, VIA or VII), no more than a 0% rating was supported.  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 hearing loss.  

BOARD FINDINGS:  In the matter of the back condition, the panel recommends a disability rating of 20%, coded 5242 IAW VASRD §4.71a.  In the matter of the hearing loss and IAW VASRD §4.87, the panel recommends no change in the PEB adjudication.  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	
Degenerative Arthritis of the Lumbar Spine	5242	20%	
Sensorineural Hearing Loss	6100	0%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170423, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record