RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00583
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20081025

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E5, Multichannel Transmitter Operator/Maintainer,  medically separated for “thoracolumbar muscle spasm” with a disability rating of 10%.

CI CONTENTION:  No specific contention made.  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 - 20080917	VARD - 20090625	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Thoracolumbar Muscle Spasm	5299-5237	10%	Chronic Thoracolumbar Strain	5237	10%	20090309	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Thoracolumbar Muscle Spasm.  According to the service treatment record and MEB narrative summary (NARSUM), the CI had a history of back pain dating back to 2005 while deployed.  He reinjured his back in February 2008 doing push-ups; X-rays in March and June 2008 were normal.  

The 29 August 2008 MEB NARSUM examination, 2 months prior to separation, noted complaints of low and thoracic back pain.  Physical examination showed a normal gait, but spasm and guarding with decreased thoracic kyphosis and lumbar lordosis.  Range of motion (ROM) testing showed flexion of 75 degrees (normal 90) and combined thoracolumbar ROM of 190 degrees (normal 240).  There was pain in all planes of motion.  ROM after repetition was 70 degrees of flexion and 180 degrees of combined motion.  
At the 9 March 2009 VA Compensation and Pension (C&P) evaluation, 4 months after separation, the CI reported daily back pain that limited his ability to lift, bend, stand or stoop.  Physical examination showed a normal gait and tenderness with no spasm or abnormal spinal contour noted.  ROM testing, after repetition, showed flexion of 60 degrees and combined motion of 205 degrees.  The examiner noted pain with flexion, extension, and left rotational movements.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5299-5237 (analogous to lumbosacral strain), citing spasm and guarding with normal gait and strength, forward flexion of 75 degrees and combined motion of 208 degrees.  The VA also rated the back condition 10%, coded 5237, based on the C&P evaluation, citing “forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees.”  Members agreed that although both the MEB and VA examinations were complete, the NARSUM was more proximate to separation and thus held more probative value than the VA evaluation. While the ROM measurements supported a 10% rating for limitation of flexion, the panel noted that muscle spasm and guarding associated with an abnormal spinal contour of both the thoracic and lumbar spine regions was present on the NARSUM examination and determined that this was a sufficient basis for a 20% rating (i.e. for muscle spasm or guarding severe enough to result in an abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis).  There was no evidence of forward flexion of the thoracolumbar spine less than 30 degrees to justify the next higher 40% rating or documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the back condition, coded 5299-5237.  

BOARD FINDINGS:  In the matter of the thoracolumbar muscle spasm condition, the panel recommends a disability rating of 20%, coded 5299-5237 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Thoracolumbar Muscle Spasm	5299-5237	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170213, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180006528 XXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

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