RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02229
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090626

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Explosive Ordnance Disposal Specialist, medically separated for “lumbosacral strain,” with a disability rating of 10%.  

CI CONTENTION:  The CI’s back condition continues to worsen and negatively impact daily activities and contends he was not evaluated for his PTSD and chronic depression conditions.  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 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 - 20090325	VARD - 20090715	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbosacral Strain	5237	10%	Capitalize Each Word	5237	20%	20090331	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Lumbosacral strain Condition.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s lumbosacral strain condition initially began after daily activities during his deployment in 2004.  The symptoms progressively worsened after two motor vehicle accidents, in December 2007 and in April 2008.  Diagnostic imaging showed mild narrowing of the posterior aspect of the L5-S1 disc space with a herniated disc at L4-5 contacting the right L5 nerve root.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “Mechanical Low Back Pain” for PEB adjudication.  

The MEB NARSUM examination on 9 February 2009, approximately 5 months prior to separation, noted constant low back pain that varied from a dull ache to a deep burning sensation rated 4-8/10 which radiated to the right and left spinal border.  The symptoms were increased with prolonged sitting, standing, walking, repeated bending, lifting, any impact activities and weight bearing on the trunk and hips.  The CI reported weekly lower back flares that lasted several hours and caused increased pain, lack of endurance, and fatigue and weakness.  He wore a back brace and had functional limitations of an inability to wear a protective bomb suit, lift and carry the associated equipment and an inability to perform any impact activities or move with a full combat load.  The physical examination findings from the MEB exam accomplished on December 2008 were cited and are summarized in the chart below.  The NARSUM examiner “speculated that there would be 10% or less further decrease in the range of motion (ROM) with the flare-ups.”  

At the VA Compensation and Pension (C&P) examination in March 2009, performed approximately 3 months before separation, the CI reported that a series of 3 epidural steroid injections seemed to help, however he still wore a back brace when he was working at home or doing heavy jobs.  A radiographic study (X-ray) showed straightening of the normal lumbar lordosis.  The physical exam findings are summarized in the chart below.  Treatment notes indicated two epidural steroid injections (ESI) following the NARSUM and prior to the PEB, and an additional ESI after the PEB and prior to separation.  

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)	MEB ~6 Mo. Pre-Sep	VA C&P ~3 Mo. Pre-Sep 	
Flexion (90 Normal)	85	60	
Combined (240)	235	200	
Comment	Painful motion; tenderness; paravertebral tightness; motor, sensory, and reflexes normal	Painful motion; Deluca negative; normal gait and neurologic exam	
§4.71a Rating	10%	20%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 5237code (lumbosacral strain), citing the general rating formula for disease and injuries of the spine.  The VA assigned a 20% rating using the 5237 code based on the VA C&P examination approximately 3 months before separation, citing forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees.  

The Board noted the limitation of thoracolumbar motion recorded in the MEB NARSUM examination and cited by the PEB met the threshold for a 10% rating.  Following the NARSUM and prior to separation there were indications that the CI’s back condition deteriorated and he had three ESIs from pain management that were not noted by the NARSUM/PEB.  The Board adjudged that the VA examination, at approximately 3 months before separation, was closest to separation and therefore more closely represented the CI’s condition at the time of separation.  Therefore the Board placed greater probative value on the VA examination.  

The Board agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 85 degrees) reported on the VA examination.  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 of20%, 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 medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Lumbosacral Strain	5237	20%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140315, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

XXXXXXXXXXXXXXX

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, AR2016001 0902 (PD201402229)

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