RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04209
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080108

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E-6, Wheeled Vehicle Mechanic, medically separated for “intervertebral disc syndrome” with a disability rating of 10%.   

CI CONTENTION:  “Please 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 - 20071001	VARD - 20080228	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Intervertebral Disc Syndrome Resulting in Chronic Low Back Pain 	5243	10%	Status Post Lumbar Spine Laminectomy	5242	20%	20071010	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40% 	

ANALYSIS SUMMARY:  

Intervertebral Disc Syndrome Resulting in Chronic Low Back Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent a multilevel lumbar discectomy in November 2006.  The 3 August 2007 MEB NARSUM (orthopedics) examination, 5 months prior to separation, noted complaints of chronic low back pain and left leg paresthesia.  He had difficulty with most activities, was unable to sit for prolonged periods and had pain with prolonged walking.  He was told by neurosurgeons to expect pain in his legs for the rest of his life.  Physical examination showed full range of motion (ROM) of the lower extremities, with 4/5 weakness, and no tenderness of lumbar spine.  The goniometric ROM evaluation by physical therapy (PT) showed averaged flexion of 60 degrees (90 normal) and averaged extension of 30 degrees (normal).  There was tenderness and muscle spasm but no abnormal gait or abnormal spinal contour.  The examiner noted the CI was unable to perform soldier or MOS specific tasks secondary to his back condition, left leg radiculopathy, paresthesia and pain.

At the 10 October 2007 VA Compensation and Pension (C&P) examination, 3 months before separation, the CI reported low back pain which radiated to his left shin with intermittent tingling and burning sensations.  Occasionally the symptoms occurred in the right leg.  He was able to perform his activities of daily living, but could not run.  He could not perform his military duties since July 2006 but worked administratively.  He had lost 4-5 months of work.  Physical examination showed a non-antalgic gait, erect posture and mild kyphosis.  There was no tenderness and strength in the lower extremities was 5/5.  The ROM evaluation showed flexion of 50 degrees and extension of 20 degrees.  There was pain with flexion and rotation.  There was increased pain with repetitive motion but it was not possible to determine the extent.  There was no sensory deprivation and reflexes were normal.  At the pain consult in June 2008, the CI reported his back pain was more bothersome than his leg pains.  

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 (IVDS)), citing combined ROM of 220 degrees, limited by pain.  The VA rated the back condition 20%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing forward flexion of the thoracolumbar spine of 50 degrees.  The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees) as reported on the MEB and the C&P examinations.  The panel considered whether a higher rating (§4.7) was achieved by using the alternate rating formula based on incapacitating episodes due to IVDS.  Although the CI had IVDS, there were no incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula for that condition.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the back condition, coded 5243.  

BOARD FINDINGS:  In the matter of the back condition, the panel recommends a disability rating of 20%, coded 5243 IAW VASRD §4.71.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Intervertebral Disc Syndrome	5243	20%	

The following documentary evidence was considered:

AR20190004437, XXXXXXXXXX 

Dear XXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.