RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03249
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060622

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard O2, Infantry Officer, medically separated for “chronic back pain status post (S/P) L5-S1 Discectomy without neurologic abnormality ” with a disability rating of 10%.  

CI CONTENTION:  “Please 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 - 20060524	VARD - 20070626	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain…	5243	10%	Lumbar Spine DDD, S/P Discectomy	5242	10%	20070511	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Back Pain  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in 2004 and resulted in an L5-S1 discectomy.  He had an uneventful recovery and said he was pain-free and able to do all of his usual required activities. During physical training in January 2006 he reinjured his lower back.  He reported sudden onset of severe lower back pain, was evaluated by a neurosurgeon, and an MRI performed on 6 February 2006 showed L1-2 bulging and some desiccated discs; L2-3 was normal; L3-4 had desiccation of the disc; L4-5 was normal; L5-S1 showed right-sided osteophyte lipping and disc herniation which was interpreted by the neurosurgeon as being a mild recurrence of his previous disc problem at that level.  

The 22 March 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints of back pain.  Physical examination showed tenderness of the lumbar spine from L4 to S1 and some para-lumbar muscle spasms, left greater than right, in this area.  His straight leg raise testing was negative at 90 degrees bilaterally.  Goniometer readings for thoracolumbar range of motion (ROM) revealed flexion to 70 degrees (normal 90) and combined ROM of 205 degrees (normal 240) with pain.  His gait was normal entering and exiting the examining room.  The CI took Darvocet-N as needed for pain. 

At the 11 May 2007 VA Compensation and Pension (C&P) examination, 11 months after separation, the CI reported low back pain.  He reported weekly moderate to severe flare-ups that lasted hours and up to 1-2 days. Physical examination showed moderate degenerative disc disease (DDD) versus post-operative changes of discectomy at L5/S1 with narrowing and osteophytosis.  Mild DDD was also noted at L3/4 and L4/5 with osteophytosis.  Thoracolumbar ROM measurements revealed flexion to 75 degrees and combined ROM was 205 degrees accompanied by painful motion.  There was no additional weakness, excess fatigability, lack of endurance, incoordination, or additional loss in ROM based on repetitive use.  A straight leg test was positive on the right.  No neurological symptoms were identified nor were disabilities diagnosed. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5243 (intervertebral disc syndrome [IVDS]), citing limitation of motion and the US Army Physical Disability Agency pain policy.  The VA also rated the back condition 10%, analogously coded 5242 (degenerative arthritis of the spine), 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 of the thoracolumbar spine 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 as reported on the MEB, NARSUM and VA 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.  There was no evidence of IVDS which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant rating under that alternate VASRD 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.  

BOARD FINDINGS:  In the matter of the back 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:

AR20190008515, 

Dear XXXXXXXXXXXXXX:

	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.

					   

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