RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03215
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080916

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Operating Room Specialist Trainee, medically separated for “spondylolisthesis L5 on S1 anterolisthesis” with a disability rating of 10%.   

CI CONTENTION:  No specific contention 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 - 20080818	VARD - 20090824	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Spondylolisthesis L5 on S1 Anterolisthesis	5239	10%	Low Back Strain	5237	0%	20090428	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0% 	

ANALYSIS SUMMARY:  

Spondylolisthesis L5 on S1 Anterolisthesis.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back condition existed 5 years prior to entering active duty, but he reported that his attendance in basic and initial entry training had made with low back pain (LBP) worse.  At the primary care appointment on 17 April 2008, 5 months prior to separation, the CI complained of LBP, and the physical examination (PE) revealed normal gait and stance with motor functions, sensation, and reflexes intact.  There was lower spine tenderness and range of motion (ROM) was normal in all directions, except for “decreased” right lateral flexion; painful motion was present.  Five days later, physical therapy noted spinal ROM as painful, but normal.  Gait and posture were normal and spinal tenderness was noted.  An X-ray on 6 May 2008 indicated bilateral vertebra slippage about the lower lumbar spine.  

At the 3 June 2008 MEB NARSUM examination, 3 months before separation, the CI had continued LBP, and the PE showed lower back tenderness and muscle spasms.  Spinal ROM measurements were normal as were strength, sensation and reflexes; an abnormal gait was not mentioned. An MRI on 27 July 2008 confirmed the previously noted vertebral slippage as well as degenerative changes and bilateral nerve impingement at the level of L5 on S1.  At the 28 April 2009 VA Compensation and Pension (C&P) evaluation, 7 months after separation, the CI continued to report LBP, but the PE was clinically detailed and completely normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5239 (spondylolisthesis), citing interference with prolonged standing and tenderness upon examination.  The VA rated the back condition 0%, coded 5237 (lumbosacral strain), citing a non-compensable evaluation and “full ROM of the lumbar spine with no objective finding of pain.”  Although there was insufficient limitation of motion to support a 10% rating, panel members agreed a 10% rating was justified for the presence of tenderness and spasm, as reported on the MEB NARSUM.  The muscle spasm was not 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 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 spondylolisthesis L5 on S1 anterolisthesis condition.    

BOARD FINDINGS:  In the matter of the spondylolisthesis L5 on S1 anterolisthesis 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 20170331, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180006216, 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