RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03004
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090317

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Computer Detection Systems Repairer, medically separated for “low back pain” with a disability rating of 10%.

CI CONTENTION:  No specific contention was made, but an 8-page list of VA conditions was attached and a review of conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB) was requested.  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20090112	VARD - 20100108	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5299-5237	10%	Lumbar Spine Degenerative Disc Disease with Left Lower Extremity Radiculopathy	5242	40%	20091021	
Adjustment Disorder…	Not Unfitting	Dysthymia Disorder…	9433	50%	20090824	
Left Patellofemoral Syndrome		Left Knee Patellofemoral Syndrome	5099-5010	10%	20091021	
Increased Blood Pressure		No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:

Low Back Pain (LBP).  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s low back condition began in early 2007 without trauma.  A lumbar MRI on 11 January 2008 showed multilevel degenerative disc disease and arthritis of the spine, without spinal canal stenosis or neuroforaminal compromise.  At a pain medicine examination on 20 February 2008 there was “nearly complete” lumbar spine range of motion (ROM), with some pain at the extremes of motion, and lower lumbar/sacroiliac joint tenderness with moderate muscle spasm.  During a neurosurgical consult on 5 May 2008, the CI reported back pain radiating to the left knee, but denied any right lower extremity symptoms.  Physical examination showed a normal gait, no spinal tenderness, negative straight leg raise testing (to elicit radicular symptoms), and normal strength, sensation and reflexes.  The neurosurgeon assessed a possible lateral recess stenosis causing left L4 radicular symptoms.  Surgical options were discussed, but the benefit was not certain.  Lumbar X-rays on 7 May 2008 were normal with well-maintained disc heights and no evidence of instability, and a thoracic spine MRI on 3 November 2008 was also normal.  The CI received conservative treatment with pain medication, physical therapy, and epidural joint steroid injections and was given an L3 profile.  The neurosurgeon opined that surgery was an option but would not recommend the procedure due to the CI’s young age.  

At a general medicine examination on 18 June 2008, 9 months before separation, the CI reported a chronic history of LBP without trauma.  Physical examination showed tenderness and thoracolumbar spine ROM was normal, with painful motion.  At a pain center consult on 6 October 2008, 5 months prior to separation, the CI reported LBP.  Physical examination showed lumbar flexion of 85 degrees (normal 90), with painful motion.  The 11 December 2008 MEB NARSUM examination, 3 months before separation, noted CI complaints of LBP.  The examiner recorded a normal gait and ability to heel and toe walk.  There was no spinal tenderness or muscle spasm, but back ROM was decreased due to pain and “probable mechanical limitations.”  At the 4 February 2009 MEB physical therapy (PT) ROM examination, 1 month prior to separation, thoracolumbar flexion was 80 degrees and combined ROM was 220 degrees (normal 240), after three repetitions and with painful motion.  There was no additional limitation after repetitive movement.  

At the 21 October 2009 VA C&P examination, 7 months after separation, the CI reported back pain radiating down the left lower extremity.  Physical examination revealed an antalgic gait with a slight limp and spinal tenderness, but no abnormal spinal curvature or muscle spasm.  After repetition, lower spine flexion was 30 degrees and combined ROM was 150 degrees, with painful motion. There was no additional loss of ROM following repetition.  A lumbar CT showed mild, diffuse degenerative disc disease.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, analogously coded 5299-5237 (lumbosacral strain), citing limitation of flexion less than 85 degrees.  The VA rated the low back condition 40%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing limitation of flexion.  Panel members noted the MEB PT ROM values supported a 10% rating, while the C&P examination values supported a 40% rating.  The VA ROM examination was 7 months after separation and the preponderance of STR evidence supported a thoracolumbar spine ROM rating of 10%.  There were no examinations prior to separation revealing such a severe limitation of motion.  While the VA examination may represent post-separation worsening of the CI’s back condition, the panel agreed it had less probative value.  The panel 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 MEB PT ROM 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 evidence of intervertebral disc syndrome 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 majority concluded there was insufficient cause to recommend a change in the PEB adjudication for the low back condition.  

Contended PEB Conditions:  Adjustment Disorder, Not Otherwise Specified (NOS), Left Patellofemoral Syndrome, and Increased Blood Pressure.  The panel's main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  The left patellofemoral syndrome and increased blood pressure conditions were not profiled, implicated in the commander's statement and did not fail retention standards.   Adjustment disorder does not constitute a physical disability IAW DoDI 1332.38.  Therefore, the panel has no basis for recommending it as unfitting.  There was no performance-based evidence from the record that any of these contended 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 low back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended adjustment disorder, NOS, left patellofemoral syndrome, and increased blood pressure 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.  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 20170422, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20190011568, XXXXXXXXXXXXXXXXXX

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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.