RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01635
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20080627

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty O3, Ordnance Officer, medically separated for “low back pain” with a disability rating of 10%.   

CI CONTENTION:  She did not receive adequate care or an accurate rating.  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 - 20080317	VARD - 20080711	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain 	5242	10%	Scoliosis of the Thoracolumbar Spine 	5237	10%	20080520	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Low Back Pain (LBP).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s LBP began in 2004 and was associated with an exercise during officer basic course.  The MRI studies from July 2005 and scoliosis survey from October 2007 showed scoliosis.  There was no surgical indication.  At the time of the physical therapy (PT) clinic appointment on 30 November 2007, 7 months prior to separation, the CI reported 3/10 pain.  Range of motion (ROM) testing, after repetition, measured flexion of 90 degrees (normal) and combined ROM of 215 degrees (normal 240).  The examination was performed using a goniometer for rotation measurements and an inclinometer for all other measurements.  There was no tenderness, muscle spasm or guarding and the CI had a normal gait, but there was dextro-scoliosis (abnormal spinal contour).  

At the 13 December 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the physical examination noted tenderness, and painful decreased ROM in all planes of movement.  Straight leg raise testing was negative and the CI had normal gait and motor strength.  The 17 December 2007 MEB NARSUM examination, 6 months prior to separation, noted complaints of intermittent back stiffness and pain which radiated to her buttocks and was aggravated by walking longer than about 10 minutes, running, jogging, carrying weight, lifting or prolonged sitting, standing or lying down.  Physical examination revealed normal gait, motor strength, sensation and reflexes.  There was tenderness, but no muscle spasm and a negative straight leg raise.  The 1 February 2008 MEB NARSUM examination, 5 months prior to separation, noted complaints of 3/10 back pain.  Prolonged walking caused increased pain.  She could only stand for about 10-15 minutes.  Physical examination showed normal gait, strength, reflexes and sensation.  Straight leg raise testing was negative, but there was tenderness.  

At the time of the chiropractic clinic appointment on 20 March 2008, 3 months prior to separation, the examiner noted tenderness, limited thoracolumbar spine range of motion and painful motion.  The gait, motor function, spinal contour and stance were normal.  

At the 20 May 2008 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported daily pain characterized by aching and stiffness with intensity level of 5-6/10.  The examiner noted the CI had not been placed on quarters, did not wear a brace, did not have surgery, and was able to perform her usual activities of daily living such as operating a motor vehicle, dressing and undressing and attending to the needs of nature without assistance.  Physical examination showed a normal gait.  The ROM study showed flexion to 90 degrees (normal) and combined ROM of 240 degrees (normal).  There was no objective evidence of painful motion, spasm or weakness, but there was tenderness.  The neurologic examination of the lower extremities revealed intact sensory and deep tendon reflexes.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5242 (degenerative arthritis of the spine), citing tenderness.  The VA also rated the back condition 10%, coded 5237 (lumbar spine strain), based on the C&P examination, citing tenderness.  The panel noted that the combined ROM of 215 degrees, as reported on the PT examination supported a 10% rating; however, the measurements were not VASRD compliant because of the use of an inclinometer.  Although there was insufficient limitation of motion to support a 10% rating, the panel agreed a 10% rating was justified for the presence of tenderness.  The panel noted the scoliosis survey and MRI studies revealed the presence of scoliosis.  However, there was no examination evidence that confirmed the presence of muscle spasm causing the altered spinal contour.  The scoliosis is consistent with a developmental curvature commonly seen as an incidental finding.  There was no evidence of intervertebral disc syndrome which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula for that condition.  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 back condition. 

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 20170221, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180008155, 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