RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX		CASE: PD-2017-04324 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20080812

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Field Artillery, medically separated for “lumbar degenerative disc disease without motor neurologic deficits” with a disability rating of 10%.

CI CONTENTION: Review requested of back condition, which continues to negatively impact his daily life, as well as additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 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 – 20080729	VARD - 20090820	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar Degenerative Disc Disease	5242	10%	Lumbar Spine Strain	5237	10%	20090407	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 60%	

ANALYSIS SUMMARY:

Lumbar Degenerative Disc Disease. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in September 2006 after his armored vehicle was disabled by an IED and he was thrust into a metal seat. He was treated with nonsteroidal anti-inflammatories and returned to duty, but continued to complain of  low back pain.   On     25 June 2007, MRI studies showed a mild central focal disc bulge at L4-L5 without significant spinal canal or neuroforaminal stenosis; he was determined to not be a surgical candidate.

The 8 April 2004 MEB physical therapy (PT) range of motion (ROM) measurements, 4 months prior to separation, showed flexion of 70 degrees (normal 90) and combined ROM of 190 degrees (normal 240) after repetition and with painful motion. Measurements were taken using both a goniometer and inclinometer. The 28 May 2008 MEB NARSUM examination, 3 months before separation, noted CI complaints of constant low back pain, rated at 4-5/10, and increased to 8- 9/10 during flare-ups. Physical examination showed slight tenderness of the left sacroiliac region, but a normal gait and no muscle spasms. The examiner referred to the PT ROM study and stated measurements were verified using a goniometer.

At the 7 April 2009 VA Compensation and Pension (C&P) examination, 8 months after separation, the CI reported pain in the small of his back radiating into the left leg, but denied any incapacitating episodes. Physical examination showed a normal gait and posture with good balance and coordination. Strength, reflexes and sensation were normal, and there was no paraspinal tenderness. Flexion was to 90 degrees and combined ROM was 240 degrees, with painful motion at extremes of motion.  There was no additional limitation following repetition.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the low back condition 10%, analogously coded 5299-5242 (degenerative arthritis of the spine), citing tenderness without spasms or abnormal contour, and forward flexion of 70 degrees with combined ROM of 200 degrees (the panel noted that the PEB apparently did not truncate the measurements which exceeded the normal standard for right rotation). The VA also rated the low back condition 10%, but coded 5237 (lumbar spine strain), based on the C&P examination, citing thoracolumbar forward flexion greater than 60 degrees but not greater than 85 degrees; or combined ROM greater than 120 degrees but not greater than 235 degrees; or objective evidence of painful motion. Panel members agreed that a 10% rating, but no higher, was justified for limitation of flexion and combined ROM reported on the MEB PT 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 documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula. While the CI may have suffered additional left leg pain, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).” 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 lumbar spine condition.

BOARD FINDINGS: In the matter of the lumbar degenerative disc disease 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:

2	PD-2017-04324

AR20200000174,

Dear XXXXXXXXXXXXXXX:

	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.