RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04600
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20091115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E2, Chaplain Assistant, medically separated for “intervertebral disc syndrome” with a disability rating of 20%.

CI CONTENTION:  “Physical impairment and Anxiety disorder have made finding steady employment an impossibility.”  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 - 20090831	VARD - 20100612	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Intervertebral Disc Syndrome	5243	20%	Scheuermann’s Compression Fracture	5235	20%	20100223	
Anxiety Disorder	Not Unfitting	Anxiety Disorder	9413	30%	20102222	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:

Intervertebral Disc Syndrome (IVDS).  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition began in January 2009 after running 3 miles wearing individual body armor.  Thoracic X-rays showed T7-10 compression fractures and MRI findings in February 2009 revealed chronic wedge compression deformities and vertebral endplate changes consistent with Scheuermann’s disease (childhood skeletal disorder with uneven vertebral posterior to anterior growth) and degenerative disc disease.  There was no surgical indication.
The 30 June 2009 MEB NARSUM examination, 5 months prior to separation, noted CI complaints of constant thoracolumbar spine pain.  Physical examination showed thoracic kyphosis (abnormal spinal contour) and spinal tenderness.  Thoracolumbar range of motion (ROM) was flexion to 55 degrees (normal 90) and combined ROM was 195 degrees (normal 240); painful motion was present.  There was no additional loss of ROM with repetitive use.  

At the 23 February 2010 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported constant back pain.  Physical examination showed no spinal tenderness, muscle spasm, guarding or weakness.  Thoracolumbar ROM was flexion to 45 degrees and combined ROM was 130 degrees; painful motion was present.  There was no additional loss of ROM with repetitive use.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 20%, coded 5243 (IVDS), citing limitation of flexion.  The VA also rated the back condition 20%, coded 5235 (vertebral fracture), based on the C&P examination, citing limitation of flexion.  Members 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 NARSUM and VA examinations proximate to separation.  There was no documentation of IVDS with incapacitating episodes which would provide for a higher rating.  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.

Contended PEB Condition:  Anxiety Disorder.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  According to the STR and the mental health (MH) MEB addendum, the CI had a history of treatment by behavioral health for insomnia and anxiety since September 2008.  He had received an Article 15 for lateness and another one was pending.  During telephone consult on 23 June 2009, the CI was advised that his medical diagnosis would likely not excuse his inability to get to work on time.  The MH MEB addendum dated 14 July 2009 noted the CI was reluctant to take any medication and had recently agreed to a trial of melatonin for sleep (over the counter sleep aid).  He was diagnosed with generalized anxiety disorder and the psychiatrist indicated this condition would not impact the CI’s occupational functioning.  The psychiatrist opined that he believed the anxiety condition would be well controlled with medication.  At MH visits after the MH MEB addendum, the CI reported improved sleep on the melatonin and a sleep medication (Restoril).  He was given an S2 profile.  A “2” profile designation indicates a condition which requires some limitations, but is not in all cases disqualifying for continued military service, although the profile did not list any limitations due to the MH condition.  The commander’s statement did not implicate MH symptoms as impairing the CI’s duty function, other than noting that the he was not able to attend early morning duties due to sleeping late.  There was no performance-based evidence from the record that the anxiety disorder significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the intervertebral disc syndrome and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended anxiety disorder, the panel agrees it cannot recommend it for additional disability rating.  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:

AR20180014221, 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.