RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03285
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090611

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Special Forces Candidate, medically separated for “degenerative arthritis of the lumbar spine” with a disability rating of 10%.  

CI CONTENTION:  He requested review of back pain, which radiates to the shoulders and legs, as well as ankle and foot pain.  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 - 20090520	VARD - 20100904	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Arthritis of the Lumbar Spine	5242	10%	Thoracolumbar Spine Strain	5242	20%	20090925	
Stress Fracture, Right Foot	Not Unfitting	Right Ankle Strain (Due to Right Foot Pain)	5271	10%	20090925	
Bilateral Hallux Valgus, Mild, Symptomatic	Not Unfitting	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Degenerative Arthritis of the Lumbar Spine.  According to the service treatment record and MEB narrative summary (NARSUM), the CI experienced low back and left ankle pain after he tripped during a basic training ruck march in January 2009.  At a primary care visit on 19 January 2009, the provider noted back tenderness, but full and painful range of motion (ROM).  Neurological findings were normal, and he was treated with duty limitations and medications.  His pain persisted, and he was referred for physical therapy and back care classes.  While he tolerated the treatment and exercise program without pain or discomfort, he again sought care for LBP in February 2009.  The provider documented full but painful ROM; X-rays on 2 February 2009 were normal.  At a follow-up visit on 18 February 2009, there was back tenderness without spasm, and full, painful ROM; neurological findings were normal.  On 1 April 2009, it was noted that the MEB could not be accomplished until 20 April 2009 (90-day minimum), and an MRI was requested and performed on 7 April 2009.  It showed disc herniation at L2-L3 and L5-S1 without nerve root displacement.  At an orthopedic visit on 10 April 2009, the back was tender, but gait and ROM were normal as was the neurological examination.  Electrodiagnostic testing for radiculopathy on 22 April 2009 was negative.  

During the 23 April 2009 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, the CI reported mid and low back pain.  Physical examination revealed limited ROM (not quantified), but normal neurological findings.  A follow-up treatment note the same day by the same examiner documented painful, full thoracolumbar and lumbosacral spine ROM; neurological findings and gait were normal.  The 29 April 2009 MEB NARSUM examination  recorded CI complaints of chronic back pain.  Physical examination revealed no localized tenderness, muscle spasm, or guarding; and no abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis.  The provider  documented an “affected” limp on the left and five (of eight) signs of non-organic pain were positive.  Thoracolumbar ROM after repetition showed flexion of 70 degrees (normal 90) and a combined ROM of 180 degrees (normal 240).  The CI was noted to be overweight with an increase of almost 40 pounds since initial presentation in January, and “grossly deconditioned.”  

At the 25 September 2009 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported back pain, but denied incapacitation.  Physical examination showed a normal gait and no evidence of radiating pain on movement.  Muscle spasm was absent and spinal contour was preserved, though there was tenderness in the lower back.  There was no guarding of movement and the examination did not reveal any weakness.  Provocative testing for nerve root irritation was negative and there was no ankyloses of the thoracolumbar spine.  Measured ROM showed flexion of 60 degrees and combined ROM of 160 degrees.  The limit of motion for all ranges was identical to the onset of pain and also identical to the ROM limits after repetition; X-rays were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5242 (degenerative arthritis of the spine), citing forward flexion of 70 degrees and combined ROM of 180 degrees.  The VA rated the low back condition 20%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing thoracolumbar flexion limited to 60 degrees.  Members 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 ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the MEB NARSUM examination which was most proximate to separation.  The panel also observed that back ROM measurements documented at numerous primary care encounters (8 times between January and the end of April) showed normal ranges.  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.  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 low back condition.  

Contended PEB Conditions:  Right Foot Stress Fracture and Bilateral Hallux Valgus.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement.  All were judged to meet retention standards.  There was no performance-based evidence from the record that any 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 degenerative arthritis of the lumbar spine and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended right foot stress fracture and bilateral hallux valgus 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 20170328, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Record  

AR20180010948, 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