RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01915
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050525

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Cable Systems Installer Maintainer Advanced Individual Trainee, medically separated for “chronic low back pain,” with a disability rating of 0%.

CI CONTENTION:  Separated from the service due to hardship.  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 - 20050425	VARD - 20131129	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	0%	Superior and Anterior Compression Fracture L-2 with Scoliosis	5235	10%	20130926	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back pain condition began in May 2002 after falling directly on her back during an obstacle course training event.  An MRI and X-ray of the thoracic spine were unremarkable.  A scoliosis survey (a specific X-ray procedure) showed a right thoracic curve and left lumbar curve.  This was thought to be the cause of the low back pain and she was referred to the MEB.

At the 1 October 2003 orthopedic examination, 20 months before separation, physical examination revealed an antalgic gait with spinal muscle spasm present.  The thoracolumbar range of motion (ROM) was full without exception; painful motion was not cited.  During the MEB process, the CI became pregnant and delivered in later 2004.  Her MEB was postponed during her pregnancy and convalescence.

At the 10 March 2005 MEB NARSUM examination, 2 months prior to separation the CI reported severe pain with standing, stooping and bending.  Physical examination showed spinal tenderness and mild scoliosis.  Gait and neurological examination were normal.  ROM was not recorded.  During a 15 April 2005 OB-GYN clinic the CI denied musculoskeletal complaints.  Physical examination revealed a normal musculoskeletal system and neurological evaluation.  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back pain condition 0%, coded 5237 (lumbosacral strain), citing 65 degrees of flexion and 33 degrees of extension.  These ROMs were not found in evidence.  The VA rated the low back pain condition 10%, coded 5235 (vertebral fracture or dislocation), based on the Compensation and Pension examination 7 years after separation, citing forward flexion greater than 60 degrees.  The panel 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 by the PEB.  Tenderness was present on the MEB NARSUM examination which also supports a 10% rating.  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.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the low back pain condition, coded 5237.

BOARD FINDINGS:  In the matter of the low back pain condition, the panel unanimously recommends a disability rating of 10%, coded 5237 IAW VASRD §4.71a.  There were no other conditions within the panel’s scope of review for consideration.  The panel 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	
Low Back Pain	5237	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150618, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170009290, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,	
Enclosure