[AR Number], XXXXXXXXXXXXXXX. 

XXXXXXXXXXXXXXXXXXXXXX, .
XXXXXXXXXXXXXXXXXXX  
XXXXXXXXXXXXXXXXX

Dear  XXXXXX:

	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 has been provided to the counsel you listed on your application; [name and address].

						      					
Enclosure

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXX	CASE:  PD-2017-04644
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20081005

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Cavalry Scout, medically separated for “chronic low back pain with spondylolysis and spondylolisthesis” with a disability rating of 10%.

CI CONTENTION:  “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 - 20080616	VARD - 20090113	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain…	5239	10%	Spondylolisthesis L5-S1with Scoliosis	5239	10%	20081029	
Asthma	Not Unfitting	Asthma	6602	NSC	20081029	
Mild Traumatic Brain Injury	Not Unfitting	Traumatic Brain Injury	9304-8045	10%	20081104	
		Post Concussive Headaches	8045-8100	10%	20081104	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Chronic Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s non-traumatic low back condition began in October 2002 during basic training.  Lumbar spine X-rays completed in March 2004 showed an L4 left-sided transition segment, grade I-II L5 on S1 anterolisthesis (upper vertebrae slips forward onto the vertebra below or spondylolisthesis), and possible L5 spondylolysis (vertebra stress fracture).  An MRI in April 2008 showed L4-L5 and L5-S1 degenerative disk disease and grade I L5-S1 spondylolisthesis/anterolisthesis.  There was no evidence of central spinal stenosis (narrowing of the spinal canal), but some degree of bilateral recess/neural foraminal encroachment (degeneration of the spinal column) was identified.  The CI was not considered a surgical candidate.

During the 24 March 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, the CI reported recurrent back pain with numbness and tingling in his legs.  Physical examination noted absence of spinal tenderness, spasm, and leg weakness.  Sensation and pulses were intact.  Spinal range of motion was flexion to 90 degrees (normal) and combined ROM was 240 degrees (normal); painful motion was present.  The 29 May 2008 MEB NARSUM examination, 5 months before separation, noted complaints of daily back pain with occasional radiation to the right leg with numbness and tingling, particularly after walking down hills or with prolonged sitting.  The examiner referenced MEB examination findings.

At the 29 October 2008 VA Compensation and Pension (C&P) examination, 1 week after separation, the CI reported low back pain which was relieved by rest and stretching, but denied incapacitation.  Physical examination noted a normal gait and spinal curvature, spinal tenderness, no muscle spasms, and normal motor and sensory function.  Spinal flexion was 90 degrees and combined ROM was 240 degrees; painful motion was not addressed.  There was no evidence of radiating pain on movement.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5239 (spondylolisthesis or segmental instability), citing painful motion (VASRD §4.59) and functional impairment (VASRD §4.40).  The VA also rated the low back condition 10%, coded 5239, based on the C&P examination, citing limitation of motion.  Members agreed that there was no limitation of thoracolumbar spine motion to support a 10% rating under the General Rating Formula for Diseases and Injuries of the Spine, as recorded by the MEB and VA examinations proximate to separation.  However, there was sufficient STR evidence of painful motion to support a 10% rating IAW VASRD §4.59, as adjudicated by the PEB.  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 low back condition.

Contended PEB Conditions:  Asthma and Mild Traumatic Brain Injury (TBI).  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  Neither of the conditions was profiled or implicated in the commander’s statement, and did not fail retention standards.  There was no performance-based evidence from the record that any of the conditions 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 any of the contended conditions, so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the chronic low back pain and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended asthma and TBI conditions, the panel recommends no change from the PEB determinations as not unfitting.  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: