RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01022
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20040721

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Medical Non-Commissioned Officer, medically separated for “strained back” 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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20040510	VARD - 20041214	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Strained Back 	5299-5237	10%	Lumbar Strain (Claimed as Back Injury and also as Back Disc Protrusion L5-S1	5237	10%	20040910	
Intermittent Left Wrist Discomfort And Weakness 	Not Unfitting	Residuals Status Post Wrist Fracture with Torn Tendon, Left 	5215	0%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Strained Back.  According to the service treatment record (STR) and the MEB narrative summary (NARSUM), the CI’s back condition began in November 2002 after a field training exercise without reported trauma.  Radiographic (X-ray) studies on 19 August 2003 were normal.  The CI was treated with conservative measures including physical therapy, steroid injections, ultrasound, heat, chiropractic manipulation, and medications; all without improvement.  Magnetic resonance imaging (MRI) studies on 20 February 2004 showed vertebral body height, alignment, and marrow signal all appeared normal with no significant facet degeneration at any level and no foraminal narrowing or canal stenosis.  A small left paracentral disk protrusion at L5-S1 was found without evident nerve root compression.  At the physical therapy clinic on 19 March 2004 the examiner noted normal gait and no visible deformity and reported range of motion (ROM) active flexion to 45 degrees (normal 90) and a combined ROM of 175 degrees (normal 240), all with repetition and not limited by pain.  

The 23 March 2004 MEB NARSUM examination, 4 months prior to separation, noted complaints of difficulty standing for long periods of time and an inability to lean forward more than 30 seconds due to pain and spasm.  Resting low back pain was 4/10, increasing to 9/10 when aggravated by lifting, prolonged standing, or strenuous activity.  He was unable to ride in tactical vehicles, lift a patient to carry from a battlefield, or bend over to drag a wounded soldier.  The NARSUM referred to a physical examination done on 24 February 2004 that showed full range of motion (ROM) of the lumbar spine with tenderness to palpation from L2 to L5 paraspinal muscles.  The examiner noted a slight right-sided paraspinal muscle spasm but was silent regarding gait and contour.  

At the 10 September 2004 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported aching, sharp pain that was elicited by physical activities and relieved by rest.  Physical examination showed tenderness with a normal gait and posture.  Thoracolumbar ROM measurements recorded active flexion of 70 degrees (normal 90) and combined ROM of 195 degrees (normal 240) associated with painful motion but no additional limitation with repetitive motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5237 (lumbosacral strain), citing muscle spasm with no neural impingement, radiculopathy, deformity, or significant loss of ROM.  The VA also rated the back condition 10%, coded 5237, (lumbosacral strain), citing limitation of forward flexion.  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 combined ROM (greater than 120 degrees but not greater than 235 degrees), as 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.  

The panel noted that the limitation of thoracolumbar motion recorded in the physical therapy appointment on 19 March 2004 met the threshold for a 20% rating.  However, members agreed that the VA examination proximate to separation was more detailed and more consistent with outpatient notes, other proximate (pre-separation) examinations, and the essentially normal MRI findings.  The MEB NARSUM also noted that the CI had full ROM.  Therefore the panel placed greater probative value on the VA examination.  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 strained back condition.  

Contended PEB Condition:  Intermittent Left Wrist Discomfort And Weakness.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended left wrist condition was not unfitting.  The panel’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The left wrist condition was not implicated in the commander’s statement nor 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 panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended left wrist condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the strained back condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended left wrist condition, the panel unanimously agrees that it cannot recommend it for additional disability rating.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends 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 20160919, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180005831, XXXXXXXXXXXXXXXXXX

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