RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03141
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080815

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard E5, Cannon Crewmember, medically separated for “L4-5 and L5-S1 spinal stenosis” with a disability rating of 10%.   

CI CONTENTION:  He still suffers from the lower back condition.  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 - 20080620	VARD - 20080828	
Condition	Code	Rating	Condition	Code	Rating	Exam	
L4-5 and L5-S1 Spinal Stenosis	5238	10%	Lumbar Spinal Canal Stenosis	5238	40%	20080206	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50% 	

ANALYSIS SUMMARY:  

L4-5 and L5-S1 Spinal Stenosis.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent an L5-S1 micro-discectomy on 15 October 2007, but continued to have low back pain.  At a physical therapy appointment on 7 December 2007, he reported aching in the low back, but the examiner noted a normal gait and stance, and no tenderness or spasm.  Thoracolumbar range of motion (ROM) was recorded as “WFL” (within functional limits).  An MRI on 14 December 2007 showed L4/5 and L5/S1 mild to moderate spinal canal stenosis due to a small annular bulge and osteophytosis; and mild degenerative disc disease without evidence of nerve root impingement.  

At the 6 February 2008 VA Compensation and Pension (C&P) examination, 6 months before separation and 4 months after surgery, the physical examination showed normal gait and posture with no evidence of radiating pain on movement, muscle spasm, or ankylosis of the lumbar spine.  There was tenderness and straight leg raising test on the right was positive for radiculopathy.  Measured ROM showed flexion of 30 degrees (normal 90) and a combined ROM of 210 degrees (normal 240).  Neurological examination of the lower extremities showed normal strength, reflexes, and sensation, and there were no signs of intervertebral disc syndrome.  

During the 9 May 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported pain and numbness in the lower back with occasional numbness under the right foot.  Physical examination showed a normal gait and heel-toe walk with no muscle spasms.  Flexion was to 75 degrees with a combined ROM of 225 degrees. The 15 May 2008 MEB NARSUM examination, noted CI complaints of constant low back pain with an average intensity of 2-3/10; flares-ups were rated at 7/10 and lasted 3-4 hours about twice a week.  The examiner noted no tenderness or muscle spasm.  Repetitive ROM testing showed flexion to 80 degrees, limited by pain, and a combined ROM of 230 degrees, with discomfort.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5238 (spinal stenosis), citing normal gait, no tenderness, spasm, or guarding, and flexion of 75 degrees.  The VA rated the back condition 40%, coded 5238, citing limitation of forward flexion to 30 degrees.  Members noted that the limitation of lumbar flexion (30 degrees) reported in the C&P examination suggested consideration of a higher rating of 40%, however the MEB examinations, performed more proximate to separation, were more detailed and compliant with VASRD rating guidelines.  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 examinations.  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.  Additionally, there was no documentation of intervertebral disc syndrome 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 L4-5 and L5-S1 spinal stenosis condition.  

BOARD FINDINGS:  In the matter of the L4-5 and L5-S1 spinal stenosis 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 20170327, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180008978, 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