RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX		CASE: PD-2017-06028 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20080204

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Construction Equipment Repairer, medically separated for “lumbar degenerative disc disease” with a disability rating of 20%.

CI CONTENTION: The back condition continues to worsen and negatively impacts daily activities. 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 - 20090219	VARD - 20080820	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar Degenerative Disc Disease (DDD)	5299-5242	20%	Lumbar Disc Disease	5243	20%	20080331	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 70%	

ANALYSIS SUMMARY:

Lumbar DDD. According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent back surgery with disc replacement in March 2004 secondary to degenerative disc disease (DDD). Electrodiagnostic studies were negative for radiculopathy. The 27 September 2007 physical therapy (PT) examination, 4 months prior to separation, showed no abnormal gait, tenderness, muscle spasm or guarding. Range of motion (ROM) testing, after repetition, showed flexion of 10 degrees (normal 90) and combined ROM of 135 degrees (normal 240) with pain. Flexion and extension were measured with non-VASRD compliant inclinometers, and side bending and rotation measurements were assessed with a long-arm goniometer.

During the 29 October 2007 orthopedic examination, approximately 3 months prior to examination, the CI reported worsening back pain aggravated by prolonged standing, heavy lifting, bending, climbing or jumping. Physical examination showed lower back tenderness and scoliosis. There was no lower extremity atrophy and straight leg raise testing was negative. She had normal sensation and reflexes and electrodiagnostic studies were negative. The ROM study showed forward flexion of 80 degrees and extension of 30 degrees (normal). Rotation and bending did not produce pain in lower extremities. The orthopedic surgeon reported the CI’s lower extremity issues improved after surgery, but her low back pain persisted. The 13 December 2007 MEB NARSUM examination, 2 months prior to separation, showed tenderness, spasm and “mild limitation in ROM due to pain.” Motor, sensory and reflexes were within normal limits and straight leg raise testing was negative. The CI could perform normal heel-to-toe and tandem walk.  Scoliosis was noted.

At the 31 March 2008 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported pain that was worse with bending, lifting, prolonged sitting or activity. Physical examination showed a limping gait, spasms and guarding. The ROM evaluation showed flexion of 45 degrees and combined ROM of 150 degrees. There was pain with motion, but no additional loss of motion due to pain, fatigue, weakness or lack of endurance following repetition.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the back condition 20%, analogously coded as 5242 (degenerative arthritis of the spine), citing limitation of forward flexion greater than 30 degrees but not greater than 60 degrees. The VA also rated the back condition 20%, coded 5243 (intervertebral disc syndrome (IVDS)), based on the C&P examination, citing flexion between 30 and 60 degrees. The panel noted the physical therapy examination provided ROM values for the lumbar spine performed using an inclinometer, which was not the goniometric thoracolumbar ROM specified by the VASRD (§4.71a, Plate V). The panel 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 VA examination (most proximate to separation). The panel noted an alternate 20% rating might also have been justified for muscle spasm severe enough to result in an abnormal spinal contour (scoliosis), as reported on the NARSUM examination. There was also evidence of muscle spasms severe enough to result in an abnormal gait for an alternate 20% rating, as reported on the VA examination, but this provided no rating benefit to the CI. There was no documentation of 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 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.

PD-2017-06028 

XXXXXXXXXXXXXXXXXXX 

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.

PD-2017-06028