RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05676
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071031

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Wheeled Vehicle Mechanic, medically separated for “L4-S1 degenerative disc disease (DDD)” with a disability rating of 10%.  

CI CONTENTION:  Evaluation did not capture the problems and CI is having continuing issues with his condition.  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 - 20071001	VARD - 20071211	
Condition	Code	Rating	Condition	Code	Rating	Exam	
L4-S1 DDD	5299-5242	10%	Degenerative Joint Disease (DJD) and DDD	5242	10%	20070626	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

DDD.   According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s L4-S1 DDD began in 2002 while working at the motor pool.  Initially, it was thought the CI pulled a muscle and so he was treated with anti-inflammatory medication.  He then deployed in December 2004 and again sought medical care for his back concerns due to flack vest wear and riding and working on vehicles.  In April 2006, he started physical therapy.  In June 2006, due to the back pain not improving, X-rays were completed and showed a mild disc space present in the lower lumbar spine.  An MRI done in October 2006 showed degenerative disc and joint disease of the lumbar spine most pronounced at L4/L5 and L5/S1.  An EMG in December 2006 was completed due to numbness and tingling in his left leg which showed chronic mild L4/L5 radiculopathy on the left.  Pain continued and a repeat MRI showed disc desiccation of L4/L5 and L5/S1, and L4/L5 broad-based annular disc bulge which contacted the thecal sac and mildly displaced it.  Facet joint degenerative changes and ligamentum flavum hypertrophy at L3/L4 narrowed the lateral recesses with no evidence of nerve root contact.  During the 4 April 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, physical examination revealed decreased range of motion (ROM) and pain.  This was worse posteriorly and on the left.  

At the 26 June 2007 VA Compensation and Pension (C&P) examination, 4 months before separation, the CI reported occasional stiffness upon waking and weakness when bending and lifting.  Physical examination showed the CI’s posture and gait were within normal limits.  There was no evidence of radiating pain on movement nor muscle spasm or tenderness.  Straight leg raise testing was negative bilaterally.  There was no ankylosis of the lumbar spine.  Thoracolumbar ROM showed flexion of 90 degrees (normal) and total combined ROM of 240 degrees (normal).  Additional limitation after repetitive use was due to pain.  Spinal motion was normal along with curvatures of the spine.  

The 24 July 2007 MEB NARSUM examination, 3 months prior to separation, noted complaints of constant back pain with increased intensity when sitting, standing 15 minutes, lifting, carrying and bending.  Physical examination showed gait and walking on toes and heels were normal.  Tenderness was present from L1 to L5 with no S1 joint pain.  Bilateral spasm on the thoracic and lower back area were noted.  Lumbar ROM performed with a goniometer was flexion at 55 degrees with pain elicited at 55 degrees, exertion at 15 degrees with pain elicited at 15 degrees, with combined ROM at 165 degrees (normal 240).  Motor strength was 5/5 and deep tendon reflexes were 2+.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the L4-S1 DDD 10%, analogously coded 5299-5242 (degenerative arthritis of the spine), citing no motor neurologic deficits and the EMG study in September 2007 was normal, however, tenderness of the paraspinal muscles was noted and the lumbar ROM was limited by pain.  The VA also rated the DJD and DDD 10%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees, or, combined ROM of the thoracolumbar spine greater than 120 degrees, but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height.  

The panel agreed that a 10% rating, but no higher, was justified for muscle spasm or localized tenderness as reported in the NARSUM.  Panel members noted that the MEB NARSUM reported lumbar ROM versus thoracolumbar ROM as required by VASRD 4.71a, therefore lumbar ROM did not meet the criteria for a higher rating based upon ROM.)  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 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 L4-S1 DDD.

BOARD FINDINGS:  In the matter of the L4-S1 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, XXXXXXXXXXXXX

Dear XXXXXXXXXXX:

	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,					      

Enclosure