RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03822
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080907

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Signal System Support Specialist, medically separated for “herniated disc at L5-S1” with a disability rating of 10%.

CI CONTENTION:  “Degenerative disc disease L4-S1 vertebrae and herniated disc L5-S1.”  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 - 20080630	VARD - 20090324	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Herniated Disc at L5-S1 	5243	10%	Degenerative Disc Disease 	5242	0%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Herniated Disc at L5-S1.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition began in July 2005 after moving heavy equipment up and down stairs.  In January 2007, an MRI showed degenerative disc disease (DDD) with moderate to severe spinal canal stenosis and mild to moderate neuroforaminal (area through which the spinal nerves exit) narrowing bilaterally, but neurosurgery determined the CI was not a surgical candidate.  His pain continued and worsened significantly in July 2007.  In April 2008, X-rays showed DDD at L4-L5 and L5-S1 levels and ankylosis of the transverse processes of L3 and L4 on the left.  An MRI in April 2008 showed DDD at L4-5 without significant spinal canal stenosis or neuroforaminal narrowing and a central disc protrusion at L5-S1 with mild central canal stenosis abutting the S1 nerve roots.    The 24 April 2008 physical therapy (PT) range of motion (ROM) examination, 4 months prior to separation, showed thoracolumbar flexion of 65 degrees (normal 90) and combined ROM of 180 degrees (normal 240).  There was onset of pain with flexion at 40 degrees.
  
During the 6 May 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, physical examination showed full ROM.  The MEB NARSUM examination on the same day, noted complaints of  localized back pain that increased with prolonged sitting, standing, quick movement or laying in the prone position.  The CI denied radiation, weakness, numbness or other neurological symptoms.  Physical examination showed normal gait and spinal contour.  There was decreased ROM secondary to pain, but it was not limited by fatigue, weakness, lack of endurance or incoordination.  There was mild tenderness without muscle spasm.  Lower extremity strength, sensation and reflexes were normal and straight leg raise testing to elicit radicular symptoms was negative.  

At the 21 May 2009, VA Compensation and Pension (C&P) examination, 8 months after separation, the CI reported persistent low back pain that worsened since discharge, with shooting pain and tingling radiating down the right leg.  A lumbar CT was performed after an exacerbation in May 2009 and showed a large disc fragment at L5-S1 compressing the right S1 nerve root.  No periods of incapacitation requiring bed rest prescribed by a physician were reported.  Physical examination showed an antalgic gait without muscle spasm.  Thoracolumbar ROM was flexion of 60 degrees and combined ROM of 175 degrees.  Pain with motion was noted on forward flexion.  Straight leg raise testing to elicit radicular symptoms was positive, but lower extremity strength, sensation, and reflexes were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5243 (intervertebral disc syndrome) citing tenderness without spasm or guarding; and flexion of 63, 65, and 65 degrees.  The initial VA Rating Decision (VARD) rated the back condition 0%, coded 5242 (degenerative arthritis of the spine), citing absence of medical evidence due to a failure to report to the scheduled VA physical examination in February 2009.  Following the C&P examination, the 8 June 2009 VARD increased the back rating to 20%.  The panel agreed that a 10% rating, but no higher, was justified at separation for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) and combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the PT MEB ROM examination.  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 intervertebral disc syndrome which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula for that condition.  The evidence showed the CI’s back condition worsened post-separation so the limitation of flexion (20%) at the time of the VA examination was not reflective of the CI’s condition at the time of separation.  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.  

AR20180015547, 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.