RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01718
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080523

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

CI CONTENTION:  “Review all conditions.”  The CI’s 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 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 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 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 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 - 20080508	VARD - 20091014	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbosacral Strain	5237	10%	L5-S1 Back Injury with Degenerative Joint Disease	5242	20%	20090521	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Lumbosacral Strain.  The nearest service treatment record (STR) clinical encounter prior to the date of separation was over 4 years remote.  Therefore, this panel’s recommendation will be based upon the Medical Evaluation Board (MEB)-driven documents.  According to the MEB narrative summary (NARSUM), the CI’s back condition began in August 2002 by getting tangled in the rope while repelling from a helicopter.  His treatment remained conservative and included medications, restrictions, and physical therapy (PT).  

At the 20 November 2007 MEB NARSUM examination, 6 months prior to separation, the CI’s chief complaint was “low back pain”.  He endorsed increasing and constant low back pain with spasms during any routine training.  His physical examination (PE) revealed thoracolumbar range of motion (ROM) as forward flexion of 65 degrees (normal 90), extension 20 degrees (normal 30), right lateral flexion of 25 degrees (normal 30), and normal left lateral flexion as well as bilateral spinal rotation.  His combined ROM was 200 (normal 240).  He had a normal gait.  There was no tenderness, muscle spasm, or guarding present. 

At the 21 May 2009 VA Compensation and Pension (C&P) evaluation, 12 months after separation, the CI reported a constant, low grade (2-3/10) low back pain aggravated by standing, bending, lifting, reaching, and sitting.  Additionally, he endorsed having frequent and severe low back muscle spasms.  His VA PE revealed tenderness and guarding of the lumbosacral spine and its adjacent muscle mass.  “There was some loss of the lower lordotic curve.”  Thoracolumbar ROM was decreased in all directions except for rotation.  Measurements were documented as forward flexion to 50 degrees, extension to 20 degrees, left lateral flexion to 20 degrees, and right lateral flexion to 25 degrees.  The combined ROM was 177 degrees.  Painful motion was present.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the condition at 10%, coded 5237 (lumbosacral strain), citing pain and limited motion without spasm or tenderness.  The VA rated the condition 20% coded 5242 (degenerative arthritis), based upon ROM measurements on the VA examination 12 months after separation.  
The panel first considered the probative value between the MEB NARSUM and the VA examination and agreed that the NARSUM examination held near exclusive probative value being 6 months closer to the time of separation.  The probative examination clearly supported no higher than a 10% rating due to limited ROM without associated tenderness, guarding, or spasms while maintaining a normal gait.  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 panel concluded that there was insufficient cause to recommend a change in the PEB’s adjudication for the low back condition.

BOARD FINDINGS:  In the matter of the low back 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 modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150614, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170008855, XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	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