RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00600
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060216

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an E5, Cryptologic Linguist, medically separated for “chronic low back pain post L5/S1 fusion,” with a disability rating of 10%.

CI CONTENTION:  “Review all conditions.”  The complete submission is at Exhibit A.

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination is based on 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(s) at the time of separation.  The panel 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 panel 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 - 20060111	VARD - 20070125	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain…	5239-5241	10%	Chronic Lumbar Strain…	5337	10%	20070106	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Chronic Low Back Pain Post L5/S1 Fusion Condition.  According to service treatment records and the MEB narrative summary (NARSUM), the CI underwent a laminectomy at L5-S1 and L5 fusion in September 2004.  Radiographic studies in August 2005 showed status post L5-S1 fusion without hardware complications, increased bone graph incorporation at the fusion site and no acute abnormalities of the sacrum.  During the physical therapy clinic appointment on 4 November 2004, performed 16 months before separation and 5 days after surgery, the CI reported 3/10 pain aggravated by twisting motions or lifting greater than 25 pounds.  There was no numbness, tingling or radiating pain.  Motor strength was 5/5 (normal) in the right lower extremity and 4+/5 in the left lower extremity.  Straight leg raise testing for radiculopathy was negative.  The examination documented forward flexion at 75 percent of full range of motion (ROM) and full extension both without pain.
At the time of the orthopedics clinic appointment on 19 August 2005, performed 6 months before separation, the CI reported doing very well with no complaints.  Leg pain was gone and lower back pain was improved since surgery.  At the time of the orthopedic clinic visit on 21 October 2005, 4 months before separation, the examiner utilized an inclometer to measure flexion and extension ROMs rather than the utilizing a goniometer as specified by VASRD (§4.71a, Plate V).  Lumbosacral flexion was 30 degrees (90 normal for thoracolumbar) and the combined ROM was 155 degrees (240 normal for thoracolumbar) with stiffness and pain.  Additionally, the examiner noted seated forward flexion to 45 degrees consistently.  At the time of the orthopedic clinic visit on 21 October 2005, 4 months before separation, the examiner measured the flexion and extension ROMs with an inclinometer rather than the thoracolumbar spine utilizing a goniometer specified by the VASRD (§4.71a, Plate V); all other planes were measured using a goniometer.  Thoracolumbar flexion was 30 degrees (90 normal) and the combined ROM was 155 degrees (240 normal) with stiffness and pain.  Additionally, the examiner noted seated forward flexion to 45 degrees consistently.

The MEB NARSUM examination on 21 October 2005, 4 months prior to separation, noted complaints of 3-7/10 lower back pain which extended to the posterior aspects of both hips and occasionally to the extended to upper aspect of the left thigh.  The physical examination showed a healed midline low lumbosacral incision.  Lower extremity motor strength was normal.  Knee jerks and ankle jerks were 1-2+ and symmetrical.  There was decreased sensation on the dorsum of the left foot consistent with a left L5 nerve root distribution.  Straight leg raise testing for radiculopathy was negative.  The ROM was taken by the aforementioned orthopedic examination.  Radiographic studies in December 2006, 10 months after separation, showed Grade I spondylolisthesis L5 on S1 which increased with flexion and extension, laminectomies L3, L4, LS and S1 with bony fusion masses along the facet joints and questionable fracture of one pedicle screw involving S1.

At the VA Compensation and Pension (C&P) examination on 6 October 2007, performed 11 months after separation, the CI reported daily dull 6/10 back pain with stiffness and weakness.  The physical examination showed a normal gait, spinal contour and reflexes.  Straight leg raise testing for radiculopathy was negative.  ROM measurements showed forward flexion of 90 degrees (90 degrees normal) and a combined ROM of 240 degrees (240 degrees normal); painful motion was present with forward flexion and there were no additional limitation after repetitive motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10% analogously coded 5239-5241 (spondylolisthesis or segmental instability - spinal fusion), citing pain-limited ROM.  The VA rated the low back condition 10%, coded 5237 (lumbosacral strain), based on the C&P examination 11 months after separation, also citing pain-limited ROM.  The panel noted the MEB NARSUM, based on the orthopedic ROM examination was performed partially with an inclinometer not a goniometer as specified by VASRD (§4.71a, Plate V).  The examiner reported a lumbosacral flexion of 30 degrees.  A normal lumbar spine flexion using an inclinometer is approximately 60 degrees and 30 degrees for the thoracic spine.  This equates to approximately 60 degrees for the thoracolumbar forward flexion.  The panel placed higher probative value on the preponderance of post-surgical STR and VA evidence which documented normal gaits and full-painful ROMs to find the CI’s back condition most closely approximated a 10% rating at separation.  There was no muscle spasm or guarding severe enough to result in abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  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 history or evidence of vertebral body fracture with loss of 50 percent or more of the height.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the chronic low back pain post L5/S1 fusion condition.

BOARD FINDINGS:  In the matter of the chronic low back pain post L5/S1 fusion condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150604, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170006525, XXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					       
						      					
Enclosure