RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05138
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080625

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E7, Bradley Fighting Vehicle System Maintainer, medically separated for “intervertebral disc syndrome (IVDS)” 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 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 - 20080519	VARD - 20080820	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Intervertebral Disc Syndrome	5243	10%	Lumbar Spine Degenerative Disc Disease (DDD) with Disk Bulging and Bilateral Foraminal Stenosis	5243	10%	20080612	
Hyperlipidemia	Not Unfitting	Hyperlipidemia, Hypertriglyceridemia	7099-7005	NSC	20080612	
Hypertriglyceridemia	Not Unfitting					
Esophagitis Chronic Reflux	Not Unfitting	Esophagitis	7299-7203	0%	20080612	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Intervertebral Disc Syndrome (IVDS).  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in 2003 while deployed to Iraq.  He fell off of a tactical vehicle and landed on his back.  Lumbar spine X-rays done in December 2007 showed a normal spine, however an MRI done the same day revealed disc bulges at L2-3. L3-4, L4-5 and L5-S1.  The worst was L5-S1 with severe neuroforaminal stenosis.  A repeat MRI in November 2007 indicated no change.  There was no surgical indication.  

At the time of the physical medicine clinic appointment on 14 March 2007, 3 months prior to separation, the CI reported progressively worsening back pain.  He rated his pain as a 4/10 at rest, a 6/10 baseline and a 9/10 at the worst.  He reported shooting pain into his right lower extremity (foot) that occurred approximately twice per week.  He also reported numbness in his right lateral lower leg from his knee to his ankle since December 2007.  His pain was worse when turning suddenly, while wearing full combat gear, and with prolonged sitting or standing.  Physical examination showed he had limited lumbar range of motion (ROM) with extension and flexion with extension worse than flexion.  There was a negative straight leg raise test and no tenderness to palpation of L4-5 and L5-S1.  Motor strength was normal and sensation was decreased to light touch over his right lateral foot.  

The 5 May 2008 MEB NARSUM examination, 2 months prior to separation, noted complaints of 
Continued low back pain. He had undergone physical therapy, tried various medications, been treated by chiropractic and been under activity limiting profiles and treated with an injection by pain management with no significant improvement.  Physical examination showed a normal stance and gait.  He had a normal motor exam (5/5 muscle strength) but decreased sensation to his right lateral calf.  Right calf reflexes were 2+.  Tenderness and spasm were present.  MRI showed lumbar spondylosis.  

At the 12 June 2008 VA Compensation and Pension (C&P) evaluation, 14 days before separation, the CI reported continued back pain.  The examiner noted that the CI did not have an antalgic gait.  His thoracolumbar ROM was 90 degrees forward flexion (normal), 30 degrees extension (normal), 30 degrees for both right and left lateral flexion (normal), 45 degrees right and left rotation (normal 30).  He had pain and stiffness with all measurements.  He was positive for Lasegue maneuver demonstrating a mild radiculopathy to his left leg.  There was no additional loss of motion, lack of endurance, fatigability or weakness with repetition.  There was no sign of spasm or tenderness to palpation and no ankylosis present.  The panel directed attention to its rating recommendation based on the above evidence.  Both the PEB and VA rated the back condition 10%, coded 5243 (intervertebral disc syndrome), citing limitation of combined ROM and limitation of motion, respectfully.  

The panel agreed that a 10% rating, but no higher, was justified for combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the MEB/PT 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.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the back condition.  

Contended PEB Conditions:  hyperlipidemia/hypertriglyceridemia/esophagitis and chronic reflux.  

The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  None of the conditions were profiled, 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 back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended hyperlidemia, hypertriglyceridemia and esophagitis/chronic reflux 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.  

Dear XXXXXXXXXXXXXXXXXXXX:

	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.

Sincerely,