RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04002
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20081027

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

CI CONTENTION:  “Please consider all conditions.”  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 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 - 20080731	VARD - 20091001	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbosacral Strain	5237	10%	Surgical Residuals, Lumbosacral Spine 	5299-5235	NSC	20090526	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Chronic Low Back Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI injured her back in an alcohol-related fall from a 30-foot height in August 2007, 14 months before separation.  Multiple fractures were identified by X-ray (transverse and spinous processes, L1-L5, without vertebral body fractures).  Although intermittent radiation (bilateral, proximal) of the pain was noted, there was no report of weakness or sensory symptoms; and, multiple neurological examinations were normal, with none to the contrary.  Several STR entries documented grossly normal range of motion (ROM), with none to the contrary.  There was documentation of normal spinal contour, no indication of gait disturbance, and no documentation of incapacitating episodes.  There was no surgical indication and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic low back pain secondary to multiple lumbar fractures of L1-L5” for PEB adjudication.

The MEB NARSUM examination on 22 July 2008, 3 months before separation, documented constant pain rated 7/10 with intermittent radiation down the left thigh, prohibiting running and exacerbated by standing or sitting longer than 10 minutes or lifting over 15 pounds.  The physical examination recorded a normal gait, tenderness, and normal neurologic findings (5/5 strength).  Measured ROM was flexion 75 degrees (normal 90) with combined ROM 215 degrees (normal 240), specifying painful motion and the absence of degradation with repetition.

A VA Compensation and Pension (C&P) examination on 26 May 2009, 7 months after separation, documented back pain dating to the 2007 fall; but, confusingly, a separate history of radiating back pain since September 2002 which was not elaborated on and was not corroborated by the STR.  The VA examiner documented “incapacitating episodes ... 4 times for 3-5 days each” and “weekly ... severe” flares of 1-2 days duration, noting left leg radiation with sensory symptoms but no subjective weakness.  The physical examination recorded a normal gait, spasm and guarding not correlated with abnormal contour, tenderness, and normal neurologic findings (motor, sensory, reflexes).  Measured ROM was normal in all planes, specifying painful motion and the absence of degradation with repetition.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating coded 5237 (lumbosacral strain), citing tenderness and the MEB NARSUM ROM evidence.  The VA did not service connect the lumbosacral spine condition but rendered analogous code 5235 (vertebral fracture or dislocation), citing the association with alcohol abuse and “willful misconduct.”  There was no ROM evidence supporting a rating higher than 10%, no evidence for abnormal gait or contour to support a 20% rating, and insufficient documentation of incapacitating episodes which would provide for a higher rating under that formula.  The Board considered whether an additional rating could be recommended for associated neuropathy, but members agreed that neither the functional link to fitness requisite for service rating nor the presence of a VASRD ratable deficit were supported by the evidence.   After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication of the lumbar spine condition.

BOARD FINDINGS:  In the matter of the lumbosacral strain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration. The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140915, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

26 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 XXXXXXXXXXXXXXXXXXXX, AR20160011777 (PD201404002)

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,
I accept the Board's recommendation and hereby deny the individual's application.
This decision is final. The individual concerned, counsel (if any), and any Members of
Congress who have shown interest in this application have been notified of this decision
by mail.

BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF:
( ) DoD PDBR
( ) DVA