RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03526
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081022

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Human Resources Specialist, medically separated for “lumbar spondylolisthesis” with a disability rating of 10%.  

CI CONTENTION:  The back condition continues to worsen and negatively impacts daily activities.  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 - 20090311	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar Spondylolisthesis	5239	10%	Lumbar Spine Disease	5243	0%	20090107	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Lumbar Spondylolisthesis.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in November 2006 during basic training.  Neuroimaging showed Grade 1 anterolisthesis of L5 on S1.  The 5 August 2008 MEB NARSUM examination, 2 months prior to separation, noted complaints of pain that was usually tolerable unless exacerbated by activity, like lifting heavy packages.  The pain increased with repetitive activity, but fatigue, weakness and instability/incoordination did not appear to be a problem separate from pain.  The condition did not affect her ability to work in her MOS.  The examiner referenced a focused back examination on 31 July 2008, which showed a non-tender back with no spasm or guarding.  Thoracolumbar range of motion (ROM) conducted by physical therapy with a goniometer on 24 June 2008, was normal with pain on left lateral rotation.  Lower extremity strength and heel, toe and tandem walk were all normal.  

At the 7 January 2009 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported back pain significantly improved with decreased physical requirements.  She often had pain with awakening that resolved with activity.  Flare-ups occurred four to five times per week and were usually associated with overexertion, lifting or carrying.  The pain usually improved after a couple of hours.  She had decreased tolerance for standing and walking activities during flare-ups.  She limited her walking to less than a mile and standing to 20 minutes or less.  She was limited to lifting 10 pounds.  Imaging of the lumbar spine was relatively unchanged.  Physical examination showed normal gait, posture and muscle strength.  There was full ROM without pain or change on repetition.  There was no guarding, spasm or tenderness. 
 
The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5239 (spondylolisthesis or segmental instability), citing §4.59 painful motion.  The VA rated the back condition 0%, coded 5243 (intervertebral disc syndrome), based on the C&P examination, citing no painful or limitation of motion.  Although there was insufficient limitation of motion to support a minimum rating on the NARSUM examination, the panel agreed a 10% rating was justified for the presence of painful motion.  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.  

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:  

Exhibit A.  DD Form 294, dated 20170412, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Record  

AR20180009195, 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