RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03210
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081127

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Signal Support Systems Specialist, medically separated for “degenerative arthritis of the lumbar spine” with a disability rating of 10%. 

CI CONTENTION:  In addition to her back condition, headaches and asthma, the CI also requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 - 20080917	VARD - 20090827 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Arthritis of the Lumbar Spine	5242	10%	Degenerative Disc Disease	5242	10%	20090604	
Chronic Headaches	Not Unfitting	Chronic Recurrent Migraine Headaches	8199-8100	10%	20090604	
Asthma	Not Unfitting	Exercise Induced Asthma	6602	30%	20090604	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Degenerative Arthritis of the Lumbar Spine.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent laminectomy at L5-S1 in July 2005.  A post-surgical MRI in May 2008 showed mild compression in the left lateral recess of S1 due to a broad-based disc bulge at L5-S1 and moderate canal stenosis at L4-L5 due to disc protrusion.  However, the neurosurgeon indicated there were no surgical options at the time.  

The 5 September 2008 MEB NARSUM examination, 3 months prior to separation, noted complaints of low back pain.  Physical examination showed localized tenderness, but no spasm or guarding.  Range of motion (ROM) testing showed 80 degrees of flexion (normal 90) with pain starting at 35 degrees.  The examiner noted the flexion increased (improved) 5 degrees after repetition, but did not indicate if the 5-degree increase was factored into the 80-degree flexion measurement.  Combined thoracolumbar ROM was 215 degrees (normal 240) with pain in all planes of motion except for extension.  

At the 4 June 2009 VA Compensation and Pension (C&P) examination, 7 months after separation, the CI reported chronic 5/10 low back pain with radiation to the toes, aggravated by vacuuming, lifting greater than 5 pounds, sitting greater than 30 minutes, driving greater than 30 minutes, running, walking greater than one mile, sit-ups, push-ups, squatting or bending.  Physical examination showed no tenderness.  ROM testing revealed 90 degrees of flexion with pain starting at 20 degrees.  Combined thoracolumbar ROM was 235 degrees with pain in all planes of motion.  Flexion decreased to 70 degrees after six repetitions.  

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, limitation of combined ROM and tenderness without spasm or guarding.  The VA also rated the back condition 10%, coded 5242, based on the C&P examination, citing forward flexion of the thoracolumbar spine greater than 60 degrees, but not greater than 85 degrees; or, combined ROM greater than 120 degrees but not greater than 235 degrees.  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/or combined ROM greater than 120 degrees but not greater than 235 degrees, as reported on the NARSUM and VA examinations proximate to separation.  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 with incapacitating episodes 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 concluded there was insufficient cause to recommend a change in the PEB adjudication for the back condition.  

Contended PEB Conditions:  Chronic Headaches and Asthma.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  Neither of the conditions was profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that either 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 back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended headache and asthma 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:

AR20180015322, 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.

Enclosure