RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-04510
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090629

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Cavalry Scout, medically separated for “spondylolisthesis” with a disability rating of 20%. 

CI CONTENTION:  No specific contention made.  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 – 20090325	VARD - 20091110	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Spondylolisthesis	5239	20%	Degenerative Disc Disease L4-5-S1 	5237	10%	20090731	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Spondylolisthesis.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began gradually without any acute injury in 2000.  His back pain steadily increased over the years despite physical therapy.  X-rays of the lumbar spine in April 2008 showed spondylolysis of the bilateral L5 pars interarticularis with otherwise normal alignment and anterolisthesis (a vertebra sliding forward on the one below it) of L5 on S1.  An MRI of the lumbar spine dated 27 June 2008 showed a small L4-5 disc bulge and an L5-S1 annular tear and an L5-S1 anterolisthesis. 

At a physical therapy range of motion evaluation on 28 October 2008, showed flexion of 55 degrees (normal 90), extension of 20 degrees (normal 30), right lateral flexion of 20 degrees (normal 30) and left lateral flexion of 25 degrees (normal 30).  Rotation measurements were not provided.  The examiner also noted tenderness of the sacrum.  

An orthopedic spine evaluation on 15 January 2009 indicated the CI was suffering from signs and symptoms of lower back pain extending into the bilateral lower extremities, left more than right, with a subjective sense of weakness as well as numbness and paresthesias in the left leg.  Various treatment options were discussed, but the CI preferred to not have surgery. 

The 20 February 2009 MEB NARSUM examination, 4 months prior to separation, noted complaints of 6/10 pain with flares due to prolonged standing or sitting.  No surgery was recommended.  Physical examination showed tenderness and tightness to the L5-S1 paraspinal muscles with a normal spinal contour and normal gait.  After repetition, thoracolumbar range of motion (ROM) measurements showed flexion of 55 degrees (normal 90) and combined ROM of 160 degrees (normal 240) with pain.  Straight leg raising (nerve root irritation) was negative.  Sensation and motor strength were normal.	

At the 31 July 2009 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported progressively worsening back pain.  Physical examination showed an abnormal gait favoring the left leg.  There was no muscle spasm, guarding or tenderness.  ROM testing showed flexion of 85 degrees and combined ROM of 235 degrees with painful motion.  There was no additional limitation with repetitive motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 20%, coded 5239 (spondylolisthesis or segmental instability), citing forward flexion limited to 51 degrees and consideration of functional loss IAW VASRD §§4.10, 4.40, 4.45, and 4.59.  The VA rated the back condition 10%, coded 5237 (lumbar spine strain), based on the C&P examination, citing forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 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 NARSUM examination.  Although the post-separation VA examination was more proximate to separation and reported flexion at 85 degrees, which warrants a 10% rating, the PDBR cannot lower the PEB rating.  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. 

The following documentary evidence was considered:

AR20180016642, 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. 

 A copy of this decision will be mailed to your counsel listed on your application: