RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:   XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02970
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090510

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Satellite Communications System Operator/Maintainer, medically separated for “degenerative arthritis, lumbar spine” with a disability rating of 10%.    

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 - 20090116	VARD - 20100806	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Arthritis, Lumbar Spine	5242	10%	Lumbar Strain with Degenerative Arthritis	5237	40%	20100315	
Migraine Headaches	Not Unfitting	Headaches	8100	30%	20100315	
Left Cubital Tunnel Syndrome	Not Unfitting	Left Cubital Tunnel Syndrome	8599-8516	10%	20100315	
Bilateral Hip Pain	Not Unfitting	Right Anterior Hip Strain	5252-5024	10%	20100315	
		Left Anterior Hip Strain	5252-5024	10%	20100315	
Tinnitus Left Ear	Not Unfitting	Tinnitus	6260	10%	20100327	
Ganglion Left Wrist	Not Unfitting	Left Dorsal Ganglion Cyst	5215-7819	0%	20100315	
GERD	Not Unfitting	GERD	7346	0%	20100315	
Anxiety Disorder	Not Unfitting	PTSD	9411	50%	20100325	
Allergic Rhinitis	Not Unfitting	Seasonal Allergic Rhinitis	6522	0%	20100315	
Infertility	Not Unfitting	Hypotestosteronism	7599-7523	NSC	20100315	
Urinary Symptoms	Not Unfitting	Neurogenic Bladder	7542	0%	20100315	
Hemorrhoids	Not Unfitting	Hemorrhoids	7336	NSC	20100315	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Lumbar Spine Degenerative Arthritis.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in April 2003 during a previous period of active duty.  The CI was separated in 2005 and re-enlisted in 2007.  On the enlistment DD Form 2807-1, the CI checked “No” for any recurrent back pain or back problems.  However, the CI reported that the original injury might have been in April 2003 and the back pain remained intermittent but progressed to constant in August 2007.  No trauma was reported.  

During the June 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 11 months prior to separation, the CI reported constant back pain.  A physical examination noted decreased range of motion (ROM), but provided no measurements.  The 16 June 2008 MEB NARSUM examination, 11 months prior to separation, noted complaints of constant low back pain.  Physical examination showed a normal gait and spinal contour and no muscle spasm, guarding or tenderness over the paravertebral musculature.  Thoracolumbar ROM measurements showed flexion of 70 degrees (normal 90) and combined ROM of 190 degrees (normal 240).  Pain was reported with flexion and left and right lateral flexion.  

Magnetic resonance imaging (MRI) studies in August 2008 showed mild disc bulge at L3-L4 with mild bilateral neuroforaminal narrowing; mild central disc herniation at L4-L5 with mild neuroforaminal narrowing; and mild to moderate central herniated disc with inferior extension with mild neuroforaminal narrowing. 

At the 15 March 2010 VA Compensation and Pension (C&P) examination, 10 months after separation, the CI reported working as a security guard and doing “a lot of sitting and some patrol.”  The CI denied any incapacitating episodes.  Physical examination showed the CI was in no apparent distress; posture and gait were normal.  The examiner noted a stiff lumbar spine when the CI got up and moved about, but otherwise the CI moved freely. There were no spasms, but there was some tenderness at the L5-S1 region.  The examiner reported lumbar flexion and not thoracolumbar motion.  Lumbar flexion was 30 degrees and combined lumbar ROM was 150 degrees.  The CI reported pain throughout all ROM.  There was no change in active ROM during repeat motion testing.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the lumbar spine condition 10%, coded 5242 (degenerative arthritis of the spine), citing forward flexion of 70 degrees and combined ROM of 190 degrees with no paraspinal tenderness, spasm or guarding.  The VA rated the lumbar spine condition 40%, coded 5237 (lumbar spine strain), based on the C&P examination, citing lumbar forward flexion limited to 30 degrees.  

The panel noted that the limitation of thoracolumbar motion recorded in the MEB NARSUM examination met the threshold for a 10% rating (greater than 60 degrees but not greater than 85 degrees).  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 evidence of intervertebral disc syndrome which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under that alternate VASRD formula.  The VA assigned a 40% rating.  The panel noted the VA examiner specified ROM for the lumbar spine and not the thoracolumbar spine as specified by the VASRD (§4.71a, Plate V).  Lumbar spine ROM was reported as 30 degrees of flexion (60 is normal for isolated lumbar flexion).  

The disparity between examinations have implications for the panel's rating recommendation.  The panel deliberated the probative value of these conflicting evaluations. The probative value of the VA evaluation was judged to be compromised by failure to properly measure thoracolumbar motion.  The panel therefore relied more heavily on the NARSUM measurements.  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.  

Contended PEB Conditions:  Migraine Headaches Left Cubital Tunnel Syndrome, Bilateral Hip Pain, Ganglion Cyst Left Wrist, Gastroesophageal Reflux Disease, Tinnitus Left Ear, Anxiety Disorder Allergic Rhinitis, Infertility, Urinary Symptoms and Hemorrhoids.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting. 

The migraine headaches were profiled (P3) in July 2008 before receiving adequate treatment from neurology; they were judged to fail retention standards.  On the March 2007 re-enlistment DD Form 2807-1 the CI denied frequent or severe headaches or treatment in an emergency room.  At the June 2008 NARSUM examination, the CI reported emergency room visits in 2006 (not on active duty), one visit in November 2007 and none in 2008. The CI reported occasional nausea and vomiting with headaches.  At the 26 August 2008 neurology clinic appointment, the CI’s medication was changed and Topamax was prescribed.  Upon follow-up with neurology on 17 October 2008 the CI reported “doing pretty well” and since starting Topamax “had maybe two migraines.”  The examiner stated the CI’s condition had improved to less than one per month on Topamax and no longer had a neurological diagnosis that failed retention standards.

All the other contended conditions were not profiled, specifically 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 contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the lumbar spine condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended migraine headaches, left cubital tunnel syndrome, bilateral hip pain, ganglion cyst left wrist, gastroesophageal reflux disease, tinnitus left ear, anxiety disorder allergic rhinitis, infertility, urinary symptoms and hemorrhoids, 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.  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 20170413, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180011795, 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