RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01315
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071108  

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Combat Engineer, medically separated for “lumbosacral strain,” with a disability rating of 10%.  

CI CONTENTION:  The applicant contends his condition continues to worsen and disrupt his daily activities.  The applicant’s 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 based upon a 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 - 20071009	VARD - 20080927	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbosacral Strain…	5237	10%	Lower back Pain	5237	10%	20080811	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:

Lumbosacral Strain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in September 2006 from a fall during a mortar attack.  He developed chronic pain in the lower lumbar region occasionally associated with radiation to the left posterior thigh.  Imaging studies showed only a small central disc protrusion at L5-S1.  There was no surgical indication.  Despite treatment including physical therapy, medications and epidural steroid injection, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and he was referred for an MEB.  The MEB forwarded “chronic low back pain” for PEB adjudication.

A physical therapy (PT) examination on 22 March 2007 (8 months prior to separation) reported that trunk range of motion (ROM) displayed “severely limited FF (forward flexion) due to pain.”  At the NARSUM evaluation on 18 September 2007 (2 months prior to separation) the CI reported localized, constant, sharp, stabbing pain of 7-8/10 severity that worsened when performing sit-ups, standing greater than 30 minutes, running and jumping.  Physical examination demonstrated lumbar tenderness and painful motion.  Thoracolumbar flexion was approximately 45 degrees (normal 90) and combined ROM was 125 degrees.  Lower extremity neurologic findings were normal.

At the VA Compensation and Pension (C&P) examination in August 2008, (9 months after separation) the CI complained of stiffness and weakness of his lower back, and constant localized pain that was 4/10 in severity.  He could function at the time of pain without use of medication.  He was a student, and could perform activities such as vacuuming, driving a car, gardening and pushing a lawn mower.  He denied incapacitation or functional impairments.  Examination showed a normal gait and spinal curves, no evidence of radiating pain on movement, no muscle spasm and no tenderness.  Thoracolumbar flexion was 90 degrees and combined ROM was 230 degrees.  Painful motion was present, and lower extremity neurologic findings were normal.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA assigned a 10% rating under 5237 code (lumbosacral strain), citing limitation of motion and tenderness (PEB) and limitation of forward flexion (VA).  The Board agreed that a 10% rating was justified for the presence of painful motion; or limitation of combined ROM noted on the NARSUM and VA examinations (greater than 120 degrees but not greater than 235 degrees).  However, it was noted that the NARSUM examination showed flexion of 45 degrees, which justified a 20% rating (for flexion greater than 30 degrees but not greater than 60 degrees).  Since this examination was more proximal to the time of separation than the VA exam, it was assigned preponderant probative value in the Board’s recommendation.  Board members thus concluded that a 20% rating was warranted.  There was no documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes which would provide for a higher rating under that formula (for IVDS), or evidence of ratable peripheral nerve impairment which would provide for additional rating.  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 the prior to medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Lumbosacral Strain	5237	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140306, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

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 XXXXXXXXXXXXXXXXXXXXX, AR20160010870 (PD201401315)

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