RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01769
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080106

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Automated Logistical Specialist, medically separated for “lumbosacral strain,” with a disability rating of 10%.

CI CONTENTION:  The CI contends his not unfitting diabetes was not rated.  The CI’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 - 20071113	VARD - 20090402	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbosacral Strain	5237	10%	DDD, Lumbar Spine	5242	10%	20080909	
Diabetes Mellitus	Not Unfitting 	Diabetes Mellitus	7913	20%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Lumbosacral Strain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in August 2005 after heavy lifting.  Imaging completed 15 June 2007 showed no spinal canal or neural foraminal stenosis (narrowing) and recorded mild lumbar posterior disk bulging and facet joint degenerative hypertrophy.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “low back pain” for PEB adjudication.  The MEB NARSUM examination on 20 August 2007, 5 months prior to separation, noted complaints of pain in the CI’s lower back near the paraspinal muscles of the lumbosacral area, with the left side slightly more painful than the right.  At times, the pain radiated into the left posterior leg to the knee.  The CI denied gross weakness in lower extremities or new onset bowel or bladder changes.  The physical examination showed normal motor testing in the upper and lower extremities.  The range of motion (ROM) was limited as charted below.  The paraspinal muscles were tender.  Tightness was recorded, but not spasm.  The gait and neurological examination were normal.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated 27 August 2007, 5 months prior to separation, the CI was noted to have decreased active ROM and tenderness to palpation.  The neurological examination was normal.  The VA Compensation and Pension (C&P) examination was performed on 9 September 2008, 8 months after separation.  The CI reported ongoing pain which was worse in the morning and radiated into his left leg.  He denied incapacitating episodes in the previous 12 months and used no assistive devices.  The CI was able to walk 1-3 miles and stand for up to 30 minutes.  Examination showed pain on motion, tenderness, guarding and spasm.  However, these did not cause the observed antalgic gait.  The ROM was limited by pain, but was not further reduced with repetition.  It is charted below.  The ROM examinations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.  

Thoracolumbar ROM
(Degrees)	PT/MEB/ ~5 Mos. Pre-Sep	VA ~8 Mos. Post-Sep	
Flexion (90 Normal)	45	90	
Combined (240)	190	235	
Comments	Painful motion	Painful motion	
§4.71a Rating	20%	10%	

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 pain-limited motion and localized paraspinal muscle tenderness.  The limitation of motion of forward flexion at 45 degrees supports a 20% rating.  The criteria for a higher rating were not in evidence.  The VA also assigned a 10% rating using the 5242 code (degenerative arthritis of the spine) based on the VA C&P examination 8 months after separation, citing degenerative disk disease (DDD) and a combined ROM greater than 120 degrees but not greater than 235 degrees.  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.  Both the PEB and VA examination are consistent with the evidence and complete.  The PEB examination is closer to separation and therefore assigned a higher probative value for rating at separation.  It supports a 20% 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 stain condition, coded 5237.  

Contended PEB Condition:  Diabetes Mellitus. The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The CI developed type II diabetes mellitus (DM) while in the MEB process.  He was prescribed lifestyle changes and begun on Metformin (treats high blood sugar levels).  There was no regulation of activities nor complications from the diabetes condition.  The commander’s statement noted the diabetes condition, but did not attribute duty impairment to it. It was listed on the profile, but the CI maintained a P1 profile; it is not clear if this was in error or not.  It was judged to fail retention standards by the MEB. The Board observes that diabetes requiring medications for control does not meet retention standards, but individuals who achieve good control (without insulin) can be found fit for duty.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  
BOARD FINDINGS:  In the matter of the lumbosacral condition, the Board unanimously recommends a disability rating of 20%, coded 5237 IAW VASRD §4.71a.  In the matter of the contended diabetes mellitus type II condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  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 medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Lumbosacral strain	5237	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140303, 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 XXXXXXXXXX, AR20160011370 (PD201401769)

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