RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:XXXXXXXXXXXXXXXXXXXX	CASE:  PD-	-	8
BRANCH OF SERVICE:  ARMY	SEPARATION DATE: 20070626
SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Power Generator Equipment Repairer, medically separated for “lumbar intervertebral disc disease” with a disability rating of 0%. “Left ankle pain” was determined to have existed prior to service (EPTS) and was not rated.
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 - 20070504	VARD - 20070823	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar Intervertebral Disc Disease…	5299-5242	0%	Degenerative Disc Disease (DDD) of the Lumbar Spine S/P Laminectomy	5242	0%	20071203	
Limitation of Motion Left Ankle with Associated
Pain	5271	EPTS	Left Ankle Degenerative Changes and Tear to the
Posterior Talofibular Ligament	5003-5271	10%	20070216	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

Lumbar Intervertebral Disc Disease. According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent back surgery for L5-S1 discectomy in April 2006. Following surgery the CI improved, but continued to report low back pain (LBP) that prevented successful performance of his duties. At the time of the orthopedic clinic appointment on 18 July 2006, 11 months prior to separation, the CI reported mild LBP. On examination there was a healed incision. Thoracolumbar range of motion (ROM) showed flexion of 80 degrees (normal 90) and extension of 30 degrees (normal). Bending and rotation did not produce symptoms. Muscle strength was equal bilaterally. Straight leg raise (SLR) test to elicit radicular symptoms was negative and there was no evidence of spinal cord compression. Deep tendon reflexes were symmetrical with slight decrease in ankle reflex.

Thoracolumbar ROM measurements performed by physical therapy (PT) on 13 February 2007, 4 months prior to separation, showed flexion of 80 degrees and combined ROM of 205 degrees

(normal 240) after repetition. Painful motion was noted. There was no tenderness, muscle spasm or guarding, and no abnormal gait or spinal contour.

The 16 February 2007 VA Compensation and Pension (C&P) examination, 4 months prior to separation, was noted to be the CI’s medical board physical examination and also served as the MEB DD Form 2808 examination. The CI reported LBP, weakness, and numbness, aggravated by prolonged walking, standing, and changes in weather. Physical examination showed a normal gait. There was no tenderness or muscle spasm of the low back. Low back ROM was flexion of 90 degrees and combined ROM of 240 degrees. There was no additional limitation of motion due to pain, fatigue, weakness, or lack of endurance after repetition. The 16 February 2007 MEB NARSUM examination noted complaints of LBP. Physical examination showed the thoracolumbar spine demonstrated full ROM.

At the 15 October 2007 C&P examination, 4 months after separation, physical examination showed a normal gait. At the 3 December 2007 VA C&P addendum examination, the CI reported constant LBP with stiffness and weakness when lifting weights. The CI reported he could function with his pain medications. The CI reported incapacitating events “as often as 6 times per month and 24 times in the past year.” Physical examination revealed no muscle spasms or radiation of pain on movement. Tenderness was present in the lumbar spine and SLR testing was negative bilaterally. There was no ankylosis present. The spine was normal in appearance with normal curvatures. Low back ROM was flexion of 80 degrees and combined ROM of 230 degrees, with painful motion with flexion noted. Lumbar spine X-rays revealed mild disc space narrowing at the L5-S1 level, otherwise a normal appearance of the lumbar spine.

The panel directed attention to its rating recommendation based on the above evidence. The PEB and VA both rated the low back condition 0%. The PEB analogously coded 5242 (degenerative arthritis of the spine), citing no limitation of motion; no neurologic deficit. The VA coded 5242 based on the February 2007 C&P examination, citing normal ROM of the spine with no pain on motion or after repetitive use.

The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) and combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the MEB PT and December 2007 VA C&P addendum examinations. 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. Although the CI reported incapacitation up to “24 times” at the VA examination, there was no evidence of incapacitating episodes due to intervertebral disc syndrome requiring physician- prescribed bed rest to warrant consideration of rating under that alternate VASRD formula. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the low back condition, coded 5299-5242.

Contended (EPTS) Condition: Left Ankle Pain. The PEB adjudicated the left ankle condition as EPTS and the panel found no evidence to indicate this was incorrect. The panel next considered if there was evidence of permanent service aggravation. A presumption of service aggravation may only be overcome by a preponderance of competent medical evidence and accepted medical principles that the natural progression of a pre-existing condition was clearly unaltered by any consequence of military service.

The 16 February 2007 MEB NARSUM noted the CI had a long history of left ankle pain with marching and running and had been on profile for a year. The 24 April 2007 MEB NARSUM addendum stated “he [the CI] has no talocalcaneal motion and limited subtalar motion associated with this tarsal coalition of the left foot. This is an existing condition prior to service. The increased demands associated with this Soldier’s [military occupational specialty] and rigors of active duty military service had exacerbated this condition and it became symptomatic while on active duty with left foot pain that was not improved with orthotics.”

The VA examination which also served as the MEB DD Form 2808 examination, showed the CI walked with a normal gait. Left ankle ROM showed dorsiflexion (DF) of 10 degrees (normal 20) and plantar flexion (PF) of 40 degrees (normal 45). Strength was normal and there was no tenderness. The CI was able to heel/toe walk without difficulty. There was no additional limitation of motion with repetition. The VA examiner noted that both a CT and an MRI showed degenerative changes and a tear to left posterior talofibular ligament. Members agreed that the PEB had not met the threshold to overcome the presumption that the unfitting left ankle condition was service aggravated and eligible for disability rating.

A 3 December 2007 addendum to a 15 October 2007 C&P examination, 5 months after separation, noted left ankle DF of 20 degrees and PF of 40 degrees. There was no pain, fatigue, weakness, lack of endurance, or incoordination after repetitive use. There was no malunion of the os calcis or astragalus. The panel directed attention to its rating recommendation based on the above evidence. The PEB did not assign a rating for the condition determined to be EPTS and not permanently service aggravated. The VA rated the left ankle condition 10%, coded 5003- 5271 (degenerative arthritis-limitation of ankle motion). The panel considered if the limitation of ankle motion was “moderate” or “marked” when considered under 5271. The panel agreed that the ROM examination at the VA pre-discharge examination, the most proximate examination to separation, was consistent with the “moderate” limitation of motion required for the 10% rating under this code. The panel considered other VASRD ankle and analogous codes and all were less applicable and/or not advantageous for rating. After due deliberation, and considering all the evidence, the panel concluded the left ankle condition was permanently aggravated by service and recommends a disability rating of 10% (coded 5003-5271).

BOARD FINDINGS: In the matter of the lumbar intervertebral disc disease, the panel recommends a disability rating of 10%, coded 5299-5242 IAW VASRD §4.71a. In the matter of the contended left ankle limitation of motion, the panel agrees it was permanently service aggravated and recommends a disability rating of 10%, coded 5003-5271 IAW VASRD §4.71a. There are no other conditions within the panel’s scope of review for consideration.

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Lumbar Intervertebral Disc Disease…	5299-5242	10%	
Limitation of Motion Left Ankle…	5003-5271	10%	
	COMBINED	20%	

The following documentary evidence was considered:

AR20200004555,

DEPARTMENT OF THE ARMY
ARMY REVIEW BOARDS AGENCY 251 18TH STREET SOUTH, SUITE 385
ARLINGTON, VA 22202-3531

Dear

The Department of Defense Physical Disability Board of Review (DoD PDBR)
reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability. I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation. This will not result in any change to your separation document or the amount of severance pay. A copy of this decision will be filed with your Physical Evaluation Board records. I regret that the facts of the case did not provide you with the outcome you may have desired.

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 also been provided to the Department of Veterans Affairs.

Enclosure

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