RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01147
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080717

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E2, Power Generation Equipment Repairer, medically separated for “low back pain” with a disability rating of 20%.  

CI CONTENTION:  “Doctors at time of separation were having a difficult time determining extent of injury.  Multiple consults were required before a determination could be 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 - 20080603	VARD - 20080730	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5299-5237	20%	Thoracolumbar Kyphosis with Thoracolumbar Dextroscoliosis without Bilateral Lower Extremity Radiculopathy	5239	20%	20080703	
COMBINED RATING:  20%  	COMBINED RATING OF ALL VA CONDITIONS:  20%  	

ANALYSIS SUMMARY:  

Low Back Pain (LBP).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s LBP condition began in November 2007 after conducting physical training.  He underwent multiple treatments with physical therapy, chiropractic adjustments, and medications without relief.  There was no surgical indication.  During a 4 April 2008 physical therapy examination for the MEB, 3 months prior to separation, active range of motion (ROM) after 3 repetitions showed forward flexion to 55 degrees (normal 90) and combined ROM of 200 degrees (normal 240) with tenderness, muscle spasm, guarding, and decreased lordosis noted.  

The 23 May 2008 MEB NARSUM examination, 2 months prior to separation, noted complaints of back pain that increased with running and wearing military gear.  Physical examination of the back was not performed; the examiner deferred to the physical therapy examination.  

At the 3 July 2008 VA Compensation and Pension (C&P) examination, 2 weeks before separation, the CI reported pain and stiffness in his back.  Physical examination showed normal gait though he was unable to walk briskly due to back pain.  Forward flexion was to 90 degrees and combined ROM was 240 degrees with pain in all planes.  Mild thoracic kyphosis and mild lumbar scoliosis were noted.  The examiner did not report tenderness or spasm and cited the findings of a 15 May 2008 scoliosis series (X-rays) finding a 15 degree thoracic curve and a 14 degree compensatory lumbar curve as well as a “severe” rotatory component to the scoliosis.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 20%, coded 5299-5237 (analogous to lumbosacral strain), citing limitation of motion.  The VA rated the low back condition 20%, coded 5239 (spondylolisthesis or segmental instability), based on the C&P examination, citing limitation of forward flexion and combined ROM.  There was no evidence of ankylosis of the entire thoracolumbar spine or decreased forward flexion to 30 degrees or less to justify a rating higher than the one adjudicated by the PEB using the General Rating Formula for Diseases and Injuries of the Spine.  There was no documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes, which would provide for a higher rating under that formula (for IVDS).  While the CI may have experienced radiating pain from the back condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the low back condition.  

BOARD FINDINGS:  In the matter of the low 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 20170221, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180007331 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