RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01423
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070901

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Wheeled Vehicle Mechanic, medically separated for “low back pain,” with a disability rating of 10%.  

CI CONTENTION:  The CI contends his condition negatively impacts his daily activities.  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 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 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 - 20070705	VARD – 20071113 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5239	10%	Spondylolysis of the Lower Back	5237	10%	20070803	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in June 2006 during Advanced Individual Training when she fell while boxing for the Army.  Magnetic resonance imaging (MRI) studies on 6 April 2007 showed vertebral body heights were well maintained throughout.  There was spondylolisthesis of L5 with respect to S1.  Despite treatment, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “L5-S1 spondylolysis – acquired,” “L5-S1 grade I spondylolithiasis” and “degenerative disc disease L4-S1” for PEB adjudication.  

The range of motion (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 ~4 Mos. Pre-Sep	VA ~1 Mos. Pre-Sep	
Flexion (90 Normal)	60, 60, 60	80, 80, 80	
Combined (240)	180	220	
Comments	Painful motion	Painful motion	
§4.71a Rating	20%	10%	

The MEB NARSUM examination on 15 May 2007 (4 months prior to separation) noted complaints of constant dull pain, although it was sharp at times, with intermittent radiating pain into the left leg and foot.  Pain increased with running, prolonged sitting, and laying in certain positions.  Physical examination noted tenderness to palpation of the left para-spinal region and no muscle spasms.  Thoracolumbar ROM was associated with painful motion.  

At the 3 August 2007 VA Compensation and Pension (C&P) evaluation, performed a month before separation, physical examination showed no muscle spasm or guarding and gait and spinal contour were normal.   Thoracolumbar ROM after repetition was limited.  There was no additional limitation after repetitive movement. Provocative maneuvers for signs of radiculopathy or radiating pain due to spinal nerve root or sciatic nerve involvement were negative.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5239 (spondylolisthesis or segmental instability), citing ROM limited by pain and tenderness to palpation of the para-spinal muscles.  The VA also rated the back condition 10%, coded 5237 (lumbosacral strain), based on the VA C&P examination a month before separation, citing forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees.  The Board noted that the limitation of thoracolumbar motion recorded in the MEB NARSUM examination met the threshold for a 20% rating.   However, the VA pre-separation examination was more detailed and performed a month prior to separation.  Therefore the Board placed greater probative value on the VA examination.  

The Board agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) and/or combined ROM (greater than 120 degrees but not greater than 235 degrees) reported on the VA examination proximate to separation.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  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.  While the CI may have experienced radiating pain from the back condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  There was no objective evidence of a radiculopathy with functional impairment (such as weakness) that directly impacted fitness for duty.  The Board therefore concluded that an additional disability rating was not justified on this basis. 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 for the back condition.  

BOARD FINDINGS:  In the matter of the back condition and IAW VASRD §4.71a, the Board 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 20150603, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170006595 , XXXXXXXXXXXXXXXXXX 

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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