RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00669
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070810

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

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 - 20070712	VARD - 20080527	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	0%	Lumbosacral Strain	5237	10%	20071116	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in 2004 when his vehicle was struck with an IED.  Diagnostic studies to include an MRI and bone scan were normal.  The 26 March 2007 physical therapy (PT) evaluation, 5 months prior to separation, documented normal lumbosacral range of motion (ROM).  There was a normal gait and posture with no back tenderness or spasm, and neurologic and motor examinations were normal.  

The 8 May 2007 MEB examination (recorded on DD Forms 2807 and 2808), 3 months prior to separation, showed a normal spine evaluation.  At the 22 May 2007 PT ROM study, 3 months prior to separation, the CI had a normal gait and posture.  ROM showed flexion of 20 degrees (normal 90) and combined ROM of 105 degrees (normal 240).  There was no tenderness, muscle spasm, guarding, abnormal gait or abnormal spinal contour.  Pain levels were noted as 6/10 before ROM and 8/10 after ROM.  At the 6 June 2007 MEB NARSUM examination, 2 months prior to separation, the CI denied radicular pain, paresthesia, weakness to the lower extremities and bowel or bladder dysfunction.  Physical examination showed no evidence of spasm or tenderness.  Lower extremities strength, sensation, and reflexes were normal.  Gait was normal and there was no evidence of kyphosis, lumbar lordosis or scoliosis.  

At the 16 November 2007 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported flare-ups that limited ROM.  Physical examination showed normal gait, sensation and reflexes.  There was tenderness to the lumbosacral area.  ROM showed flexion of 80 degrees and combined ROM of 230 degrees (normal 240) with painful motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 0%, coded 5237 (lumbosacral strain), citing ROM limited by pain.  The VA rated the back condition 10%, coded 5237, citing ROM of 80 degrees and combined ROM of 230 degrees, tenderness and painful motion.  

In assigning probative value to these somewhat conflicting examinations, the panel noted that the significant PT MEB ROM limitations were not corroborated by objective findings of significant spasm or guarding on physical examination and were not consistent with other proximate (pre-separation) examinations by primary care and PT, as well as the normal diagnostic imaging findings.  The PT ROM evaluation was considered a clear outlier.  The VA measurements were consistent with the diagnostic and clinical pathology in evidence, normal imaging, consistent observations of normal gait and posture, and the preponderance of the back evaluations in evidence proximate to separation.  Therefore, based on all evidence and the associated conclusions just elaborated, panel members agreed that preponderant probative value should be assigned to the VA examination.  

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.  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 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 10% for the back condition, coded 5237.  

BOARD FINDINGS.  In the matter of the back 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 the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Low Back Pain	5237	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170222, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20180004731, 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