RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05432
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080828

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Motor Transport Operator, medically separated for “lumbar degenerative disc disease without motor neurologic deficits ” with a disability rating of 20%.  

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 - 20080521	VARD - 20090716	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar Degenerative Disc Disease…	5299-5242	20%	Degenerative Disc Disease and Lumbosacral Disk Arthropathy	5242	10%	20081204	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Lumbar Degenerative Disc Disease.  According to the service treatment record and MEB narrative summary (NARSUM), the CI experienced low back pain (LBP) in 2003 after falling off a truck while deployed, and was successfully treated for intermittent pain with anti-inflammatory medication and physical therapy (PT) until 2005, when she was referred to the pain clinic for epidural steroid injections.  She had no significant improvement, and after a neurosurgery consult, was deemed a non-surgical candidate based on MRI results and clinical history.  

During the 15 February 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI complained of constant, sharp and stabbing right sided back pain, as well as  constant, dull and throbbing tailbone pain.  She reported low back muscle spasms associated with prolonged standing and activities, and pain aggravated by sitting straight up, standing for more than 75 minutes, fast or excessive walking, running, bending, lifting, twisting motions, push-ups, sit-ups, and carrying weight/gear.  Physical examination showed an abnormal gait and paraspinal muscle tenderness on the right side.  Range of motion (ROM) was described as limited by pain with decreased flexion, extension, lateral flexion, and rotation.  Straight leg raising and Waddell’s tests were negative.  

The 24 March 2008 MEB NARSUM examination, 5 months prior to separation, noted CI complaints of LBP and the inability to run or wear battle gear or Kevlar, and difficulty lifting greater than 10-20 pounds.  Her baseline pain was rated at 4-5/10, with significant exacerbation after frequent bending or lifting.  When lifting, she had spasms that lasted approximately 30 minutes.  During exacerbations, she had decreased ROM, with the only relief from laying down on a heating pad.  Physical examination showed back tenderness over the bilateral paralumbar muscles on L4-L5, with L5 greater than L4 and on the spinous processes.  She was non-tender over the bilateral sacroiliac joints and sciatic notches, and had good 5/5 motor distally.  There was normal sensation and gait.  

During the 12 May 2008 MEB PT ROM evaluation, 3 months before separation, the CI complained of LBP rated at 4/10.  Goniometrically measured ROM showed flexion of 60 degrees (normal 90) and combined ROM of 190 degrees (normal 240) after repetition, with painful motion.  The examiner noted a normal gait and no abnormal spinal contour, localized tenderness, muscle spasm, or guarding.  

At the 4 December 2008 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported daily, central lumbar spine pain with flare-ups after any strenuous activity.  Physical examination showed a normal gait and posture, and no spasms, weakness, atrophy, or tenderness.  Flexion was to 85 degrees and combined ROM was 215 degrees, after repetition.  Repetitive motion did not change ROM, but there was pain with all movements.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 20%, analogously coded 5299-5242 (degenerative arthritis of the spine), citing forward flexion of 60 degrees.  The VA rated the low back condition 10%, coded 5242, based on the C&P examination, citing painful motion.  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 PT examination.  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.  

BOARD FINDINGS:  In the matter of the low 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.   

AR20190006187, XXXXXXXXXXXXXXXXXX

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.