RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03895
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090626 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E5, Light Wheel Vehicle Mechanic, medically separated for “degenerative arthritis of the spine” with a disability rating of 10%.   

CI CONTENTION:  “My disability has had major impacts to my quality of life…pain medication are now affecting my life…require a liver specialist….diagnosed with severe sleep apnea…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 - 20090504	VARD - 20100630	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Arthritis of the Spine	5242	10%	Lumbar Spine L4-L5-S1 DDD	5242	10%	TR*	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	
(*Treatment Records (TR))

ANALYSIS SUMMARY:  

Degenerative Arthritis of the Spine.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition began in 2006 without any specific triggering events.  The CI was evaluated while deployed to Iraq and diagnosed with back strain, with persistent complaints of pain ranging from 6-7/10 in intensity.  On redeployment, the CI was sent to physical therapy without significant benefit.  Surgery was not indicated and the CI underwent multiple epidural nerve root and facet joint blocks with no reported benefit.  An MRI of the lumbosacral spine revealed mild multi-level degenerative disc disease without significant central spinal canal or neuroforaminal narrowing/nerve root impingement at any level.  At an orthopedic examination on 9 February 2009 the CI reported low back pain that radiated down the left lower extremity.  Physical examination showed normal strength and gait, sensation, and reflexes of the lower extremities.  No surgery was recommended.  

During the 9 February 2009 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, physical examination revealed mild tenderness over the left paraspinal muscles.  LBP was present with active range of motion (ROM) though no ROM measurements were provided.  The 23 February 2009 MEB NARSUM examination, 4 months prior to separation, noted complaints of back pain that increased with activity (running, lifting, pushing or pulling) and required increased medication.  The CI was using pain medication (a narcotic) daily.  Intermittent left leg numbness was reported, but no bowel or bladder dysfunction was present.  Physical examination performed on 19 February 2009 showed forward flexion was 70 degrees (normal 90) and combined ROM was 220 degrees (normal 240) after three repetitions.  Back appearance was normal.  Tenderness was present over the lumbosacral area.  Straight leg raise testing to elicit radicular symptoms was positive on the left.  Reflexes and muscle bulk, power, tone, and coordination were normal.  There was no VA examination proximate to separation in evidence.

At the 29 September 2009 VA primary care examination, 3 months after separation, the CI reported back pain that radiated to the posterior legs, left greater than right.  Physical examination showed normal gait, ankle to heel, and toe walk.  Pain was noted with lumbar extension and flexion.  Tenderness of the lower lumbar spine was present.  Strength, sensation and reflexes were intact. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the degenerative arthritis of the spine condition 10%, coded 5242 (degenerative arthritis of the spine), citing tenderness, normal reflexes, normal strength and ROM at 70 degrees forward flexion.  The VA also rated the lumbar spine L4-L5 and L5 and L5-S1 degenerative disc disease (DDD), 10%, also coded 5242, based on the treatment examination, citing X-ray evidence of degenerative changes with painful motion and forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees.

The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) as reported on the NARSUM examination.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour noted, 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 degenerative arthritis of the spine condition.  

BOARD FINDINGS:  In the matter of the degenerative arthritis of the spine condition and IAW VASRD §4.71, 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.  

AR20190010865, XXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXX:

	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.