RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01824
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20070520

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, AH-64 Attack Helicopter Repairer, medically separated for “chronic back pain, status post L2-3 fusion” with a disability rating of 10%.

CI CONTENTION:  Evidence supports a higher 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 - 20070321	VARD - 20070725	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5241	10%	Fusion, Lumbar Spine L2-L3	5241	10%	20070523	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:

Chronic Back Pain.  According to the service treatment record and the MEB narrative summary (NARSUM), the CI’s back condition began in 2002 during basic training without specific injury or trauma.  In March 2006 the CI underwent an L2-3 spinal fusion.  Postoperative X-rays showed good hardware position and fusion consolidation.

At the 15 August 2006 orthopedics evaluation, 5 months after surgery and 9 months prior to separation, the CI reported continued low back pain aggravated by sitting.  The CI denied bowel or bladder incontinence, limb weakness, tingling or numbness.  Physical examination revealed a negative straight leg raise test for radiculopathy.  Sensation and reflexes were normal.  Range of motion (ROM) testing was not performed.  
At the 22 February 2007 MEB NARSUM examination, 3 months prior to separation, the CI reported constant low back pain with intermittent pain radiating to the legs; aggravated by standing, lifting, lying down, prolonged sitting and any impact activities.  Physical examination showed spinal tenderness and muscle spasm.  Straight leg raise testing was negative and sensation was intact.  The MEB ROM study was performed by physical therapy on 5 February 2007.  The examiner noted the CI had a normal gait and posture with no spinal tenderness, muscle spasm or guarding.  Flexion was 75 degrees (normal 90) and combined ROM was 180 degrees (normal 240); painful motion was present.

During the 23 May 2007 VA Compensation and Pension (C&P) evaluation, less than 1 month after separation, the CI complained of constant-achy low back pain aggravated by running, bending and sleeping, and he could not lift more than 30 pounds.  The CI denied bowel or bladder incontinence.  Physical examination showed a normal gait and posture with spinal tenderness.  Repetitive ROM was flexion of 90 degrees and combined ROM of 240; painful motion was elicited.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5241 (spinal fusion), citing pain limited motion, tenderness and muscle spasm.  The VA also rated the back condition 10%, coded 5241, based on the C&P examination less than 1 month after separation, citing painful motion.  

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/or combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the MEB physical therapy 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.  The panel concluded there was no evidence to support a rating higher than that adjudicated by the PEB.  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 20170215, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180008183, 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