RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	 CASE:  PD-2014-01275
BRANCH OF SERVICE:  Army	Separation Date:  20080221

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, Unit Supply Specialist, medically separated for “lumbosacral strain” with a disability rating of 10%.  

CI CONTENTION:  She would like resolution of benefits to which she is entitled.  Her complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited 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 PEB, but determined to be not unfitting.  Any conditions outside the Board’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.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20090318	VA - 20090108	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbosacral Strain 	5237	10%	Lumbar Spine Degenerative Changes	5237	10%	20081017	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Lumbosacral Strain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back condition began in February 2006 after falling off a military vehicle.  Radiographic studies (X-ray, MRI) were essentially normal.  There was no surgical indication.  The MEB NARSUM examination performed 5 December 2007, approximately 3 months prior to separation, noted complaints of constant sharp stabbing low back pain (LBP) localized to the L5-S1 area rated at 5-8/10.  The pain worsened with prolonged standing greater than 30 minutes, bending, running and jumping.  The CI denied any leg weakness.  The CI had functional limitations of an inability to lift more than 20 pounds, mount or dismount from a tactical vehicle, wear Kevlar and perform push-ups, sit-ups and running.  Physical exam findings are summarized in the chart below.  
At the VA Compensation and Pension (C&P) examination on 17 October 2008, approximately 8 months after separation, the CI reported constant LBP with radiation to the outside of her left thigh to the foot with occasional leg weakness that occurred once or twice weekly and lasted for an entire day.  During flares she “stops driving, if driving.  If sitting, stands up, but has a hard time getting out of chair, may require help.”  Physical examination findings are summarized in the chart below.  Radiographs documented mild rotoscoliosis with minimal degenerative changes.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 5237 code (lumbosacral strain), citing “exam shows range of motion is 60 degrees flexion, and tenderness to palpation for which rated 10% IAW VASRD General Rating Formula…”  The VA assigned a 10% rating using the 5237 code based on the VA C&P examination approximately 8 months after separation, citing that the CI’s combined ROM of 200 degrees met the 10% rating criteria.  

The Board adjudged that the MEB examination was closest to separation and had the highest probative value for rating.  The Board considered that the “approximately 60” degrees forward flexion (with all other planes of motion measured as 20 or 25 degree) was a valid ROM of forward flexion limited to 60 degrees.  Forward flexion of 60 degrees at that exam (and as cited by the PEB), met the 20% rating criteria of:  “forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees.”  There was no evidence of further ROM limitation, ankylosis or periods of incapacitation to support any rating higher than 20%.  

The Board also considered if an additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI denied any leg weakness at the MEB NARSUM examination, but reported occasional leg weakness at the VA examination.  The presence of functional impairment with a direct impact on fitness is the key determinant in the Board’s decision to recommend any condition for rating as additionally unfitting.  While the CI may have suffered additional pain from the nerve involvement, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  Therefore the critical decision is whether or not there was a significant motor weakness which would impact military occupation specific activities.  Both the MEB and VA examinations indicated normal gait, without any fixed motor, sensory or reflexes deficits.  There was no evidence in this case that motor weakness existed to any degree that could be described as functionally impairing.  The Board therefore concluded that an additional disability rating was not justified on this basis.  

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the lumbosacral strain condition, coded 5237.  

BOARD FINDINGS:  In the matter of the lumbosacral strain condition, the Board unanimously recommends a disability rating of 20%, coded 5237 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

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

UNFITTING CONDITION	VASRD CODE	RATING	
Lumbosacral Strain 	5237	20%	
RATING	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140310, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

14 JUL 2016

MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXX, AR20160005881 (PD201401275)

1 . I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual. Under the authority of Title 10, United States Code, section 1554a, accept the Board's recommendation to modify the individual's disability rating to 20% without re-characterization of the individual's separation. This decision is final.

2. I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.

3. I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

CF:
( ) DoD PDBR
( ) DVA