RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05550
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080620

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Health Care Specialist, medically separated for “lumbar degenerative disc disease [DDD]” with a disability rating of 10%.

CI CONTENTION:  A higher rating should be provided due to muscle spasms.  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 – 20080408	VARD - 20081125	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar DDD	5299-5242	10%	Lumbar Spine DDD With History of Disc Bulging and Radiculopathy	5242	10%	20071227	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Lumbar DDD.  According to the service treatment record and MEB narrative summary (NARSUM), the CI experienced back pain while doing physical training in Advanced Individual Training.  She did not seek care until 9 June 2005, where she reported low back pain that radiated to the buttocks and thighs.  MRI studies on 3 October 2006 revealed disc dehydration at multiple levels, annular tear at L3-L4 and degenerative facet joint disease at L3-L5.

Thoracolumbar range of motion (ROM) measurements performed by physical therapy (PT) on 20 December 2007, 6 months prior to separation, showed flexion of 45 degrees (normal 90) and combined ROM of 165 degrees (normal 240) after repetition, with ROM limited by pain.  There were no spasms.  Forward flexion and extension were assessed with an inclinometer; lateral side bends, and rotation measurements utilized a goniometer.  

The 27 December 2007 MEB NARSUM examination, 6 months prior to separation, noted complaints of back pain usually 4/10 with several flare-ups to 7/10 for several hours occurring several times a week.  Physical examination showed a normal posture and gait.  The lumbar spine was not tender and there were no muscle spasms.    Flexion and combined ROM were normal.  The CI reported she was under the analgesic effects of pain medication.  At the same-day VA Compensation and Pension (C&P) examination, the CI reported pain aggravated by prolonged standing, staying in bed, and bending.  Physical examination showed a normal posture and gait, and no tenderness or spasm.  Flexion and combined ROM remained normal with no limitations from pain, fatigue, weakness, or lack of endurance with repetitive use.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5299-5242 (degenerative arthritis of the spine), citing painful motion.  The VA also rated the back condition 10%, coded 5242, based on a C&P examination done in September 2008 (not in evidence), citing limited motion.  Although the September examination was not found in evidence the ROM measurements were provided in the VARD.  There was flexion of 90 degrees and combined ROM was 205 degrees.  There was no objective evidence of spasm, atrophy, guarding, pain with motion, tenderness, or weakness.  Posture and gait were normal.  

The panel noted the MEB PT ROM examination provided ROM values performed using both an inclinometer and goniometer, which was not the goniometric thoracolumbar ROM specified by the VASRD (§4.71a, Plate V).  Furthermore a treatment note from the physical therapist dated 28 January 2008 (same examiner who performed the 20 December ROM examination) stated she advised the CI to come back for ROM measurements, because she noticed she had the wrong landmarks on her measurements.  No new ROM measurements were found in evidence.

The paneled determined the PT ROM examination had the least probative value.  No other examination in evidence supported a rating higher than 10%.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour on any examination, thus the next higher 20% rating was not justified on this basis.  There was no documentation of intervertebral disc syndrome (IVDS) 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 back condition.  

BOARD FINDINGS:  In the matter of the lumbar degenerative disc disease 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.   

ARXXXXXXXXXXX, XXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXX:

	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.