RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00629
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20080928

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Power-Generation Equipment Repairer, medically separated for “lumbosacral strain” with a disability rating of 10%.

CI CONTENTION:  Disabilities should be rated higher.  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 - 20080701	VARD - 20090121	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbosacral Strain	5237	10%	Degenerative Joint Disease and Disk Disease with L5-S1 Herniation	5243-5242	10%	20090121	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Lumbosacral Strain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in the summer of 1999 after falling while carrying a moderate-to-heavy equipment load.  Symptoms worsened in 2004 without specific injury or trauma.  A primary care note in December 2006 indicated the CI was involved in a motor vehicle accident prior to enlistment and had surgery on the lumbar spine in 2002.  X-rays were normal and MRI showed a broad-based disc bulge at L5-S1 with narrowing of the right lateral recess and neural foramen (space through which the spinal nerve root passes) with encroachment on the right exiting L5 spinal nerve root.  X-rays dated 17 March 2008 demonstrated mild narrowing of the posterior aspect of the L5-S1 disc space.  There was no surgical indication. 
During the 17 March 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported that he was able to continue to perform the duties of his military specialty despite his profile restrictions.  Physical examination showed full active range of motion (ROM) of the thoracolumbar spine with pain at the end ranges of flexion and extension and increased pain with repeated flexion and extension.  There was no weakness, fatigue, lack of endurance, instability or incoordination with repeated ROM movements, but there was an additional decrease of approximately 5 degrees of flexion and extension noted.  There was no tenderness or spasm. The neurologic evaluation showed normal motor strength, reflexes, and sensation and straight leg raise testing (to determine nerve root irritation) was negative bilaterally.  An MRI dated 24 March 2008 demonstrated degenerative change at L4-5 and L5-S1 mild facet degeneration at L3-S1.  

At the 7 April 2008 physical medicine consultation, 6 months prior to separation, the CI complained of 4/10 back pain with flare-ups following vigorous physical activity.  Pain was worse with running, wearing body armor or combat loads, doing sit-ups, leg lifts or flutter kicks, and driving over rough terrain.  On examination the CI was able to reach to about his knees “before the onset of right-sided back pain.”  Extension was slightly reduced with pain on the right side.  Lateral flexion was normal without pain.  Rotation was not addressed.  No ROM measurements were included in the examination.  There was spinal tenderness with guarding and muscle spasms around the L5 region on the right.  The CI’s gait was normal and there was no mention of abnormal spinal contour.  Motor strength and reflexes were normal and straight leg raise testing was negative. 

The 8 May 2008 MEB NARSUM examination, 5 months prior to separation, noted complaints of lower lumbar spine pain rated at 2-9/10 that “increased with prolonged standing, walking, climbing, repeated bending and lifting, and bearing weight on the back and hips.”  Physical examination showed full active ROM with pain beginning at 70 degrees of flexion and ending at 90 degrees (normal 90) and pain beginning at 25 degrees of extension and ending at 30 degrees (normal).  Left and right lateral flexion and left and right rotation were all 30 degrees (normal) without pain.  There was increased pain with repeated ROM and use, but no weakness, fatigue, lack of endurance, instability or incoordination.  There was a decrease of less than 5 degrees of ROM in flexion and extension with repetition.  There was no tenderness, spasms, or spinal deformity.  Motor strength, reflexes, and sensation were normal and bilateral straight leg raise testing (to determine nerve root irritation) was negative.  

At the 21 January 2009 VA Compensation and Pension (C&P) evaluation, 4 months after separation, the CI reported 5/10 back pain that occasionally radiated to the lower extremities and was occasionally associated with tingling and numbness of the lower extremities.  The CI denied weakness or paresis.  His pain increased with sitting for more than an hour, standing more than 30 minutes, lifting greater than 30 pounds, walking for more than two miles, or climbing more than two flights of stairs.  Physical examination showed a normal gait with minimal tenderness and no muscle spasm or abnormal spinal contour.  “Dorsolumbar spine” (thoracolumbar) ROM measurements, after repetition, were 60 degrees of flexion and combined ROM of 180 degrees (normal 240).  ROM movements were not painful.  Straight leg raising and Lasègue’s sign (to determine disc herniation/nerve root irritation) were negative. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5237 (lumbosacral strain), citing painful motion.  The VA also rated the back condition 10%, coded 5243-5242 (intervertebral disc syndrome due to degenerative arthritis of the spine), based on the C&P examination, 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.”  Although the post-separation VA examination supported a rating of 20% based on the flexion measurement of 60 degrees, this measurement was inconsistent with other pre-separation examinations that showed full active ROM, albeit with painful motion.  Furthermore, there was no evidence or report of an accident or injury to account for the decrement in flexion or other ROMs.  Therefore, the panel assigned more probative value to the pre-separation examinations proximate to separation.  The panel agreed there was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, or limitation of motion to support a rating higher than the 10% adjudicated by the PEB.  There was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula.

BOARD FINDINGS:  In the matter of the back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  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 20170213, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180004717, 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