RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03994
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20081020

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E2, Basic Trainee, medically separated for “degenerative arthritis of the spine” with a disability rating of 10%.

CI CONTENTION:  The current condition supports a higher rating.  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 - 20080917	VARD - 20090313	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Spine Degenerative Arthritis	5242	10%	L5-S1 Bulging Disc & Mild Foraminal Narrowing	5242	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Spine Degenerative Arthritis.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition began in April 2008 when he felt a sharp pain in his back during physical training.  An MRI showed mild degenerative disc disease (DDD) at L5-S1 with minimal neuroforaminal narrowing.  He was unable to complete his advanced individual training in his military occupational specialty and was re-classified but again was unable to complete training.  

A primary care evaluation on 26 June 2008 noted that despite being on profile the CI complained of back pain with increasing severity.  Physical examination showed a normal gait and stance with no tenderness.  There was normal lumbar spine range of motion (ROM) with pain at the ROM extremes.  A primary care evaluation on 9 July 2008 noted complaints of “excruciating” back pain with radiation to the legs; this was present on awakening and aggravated by bending.  Physical examination noted the CI’s gait was “shuffling” and “stooped.”  There was tenderness of the lumbar spine and movement provoked muscle spasm and pain. Lumbar spine X-rays performed on 13 August 2008 showed straightening of the lumbar spine in lateral projection due to patient positioning or muscle spasm.  Repeat MRI performed on 20 August 2008 showed DDD at L5-S1 with moderate foraminal narrowing.  

The 25 August 2008 MEB NARSUM examination, 2 months prior to separation, noted complaints of low back pain.  The CI reported his back pain had worsened over the last 6 months and was aggravated by running, bending, lifting, or prolonged standing, and improved with sitting or lying down.  Physical examination showed a normal gait and station with normal spinal contours.  There was no tenderness of the lumbar spine and no evidence of radiating pain or muscle spasm.  Muscle strength was normal.  Thoracolumbar spine ROM was flexion to 90 degrees (normal) and combined ROM was 225 degrees (normal 240); painful motion was present.  There was no limitation of motion due to fatigue, weakness, lack of endurance, or incoordination.  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5242 (degenerative arthritis of the spine), citing flexion of 90 degrees and combined ROM of 235 degrees with painful motion.  The VA also rated the condition 10%, using the same code (5242), based on the STR, citing painful motion.

The panel agreed that a 10% rating, but no higher, was justified for combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the MEB NARSUM examination proximate to separation.  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.

AR20180015900, 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.