RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00388
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061016

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E4, Motor Transport Operator, medically separated for “chronic thoracolumbar mechanical back pain…” with a disability rating of 0%.

CI CONTENTION:  The CI requested a review of all 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 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 - 20060929	VARD -  None	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Thoracolumbar Back Pain…	5237	0%	No VA Claim in Record	
Normal Variant EKG [Electrocardiogram]  Per Cardiology Service	Not Unfitting		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Thoracolumbar Back Pain.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back pain with intermittent lower extremity numbness of both legs and the left upper extremity began in late April 2006, 1 month after participating in Urban Operations Training.  Diagnostic imaging of the thoracic and lumbar spines were unremarkable.  Despite physical therapy (PT) treatments, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and he was referred for a MEB.  The MEB forwarded “somatic dysfunction of the thoracic spine resulting in chronic constant back pain in this area” for PEB adjudication.  An orthopedic evaluation conducted on 20 June 2006 (4 months prior to separation) noted no complaints of radiculopathy or peripheral numbness or tingling and the physical examination (PE) was normal.  At the MEB NARSUM examination performed on 23 August 2006 (2 months prior to separation), the CI endorsed a constant non-radiating mid and upper lumbar spine pain rated at 4-5/10 scale.  "It is exacerbated by any sort of strenuous physical activity."  "It is worsened by physical training." "It is also worsened by the vibrations from sitting in a vehicle during vehicular operations."  His PE was detailed and revealed painful and decreased thoracolumbar range of motion (ROM) of flexion at 60 degrees (normal 90) and lateral flexion of 20 degrees bilaterally (normal 30).  The case file did not contain any evidentiary records to indicate that the CI had applied for or had received a rating from the VA.      

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the thoracolumbar condition 0%, coded 5237 (lumbar spine strain), citing flexion limited by pain alone (no mechanical block).  There is no record of the VA rating the thoracolumbar condition.  The Board deliberated and the majority of members agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees) reported on the MEB PT examination.  There was no evidence of intervertebral disc syndrome (IVDS) which resulted in incapacitating episodes requiring physician prescribed bed rest to warrant consideration of rating under the alternate VASRD formula (for IVDS).  There was no evidence of an associated unfitting radiculopathy for consideration of a separate peripheral nerve rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board majority recommends a disability rating of 20% for the thoracolumbar condition, coded 5237.

Contended PEB Condition: Normal Variant Electrocardiogram.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  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 low back condition, the Board by a majority vote, 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 medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Thoracolumbar Pain	5237	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150530, 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

21 DEC 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160018715 (PD201500388)

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