RECORD OF PROCeediNGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02095
BRANCH OF SERVICE:  army	SEPARATION DATE:  20080207

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Armament Repairer, medically separated for “chronic low back pain (LBP) with fixed anterior left sacroiliac joint dysfunction” with a disability rating of 10%.

CI CONTENTION:  The back condition should have been rated higher.  Additional requests were made for review of neck and mental health conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20080207	VARD - 20080306	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain…	5236	10%	Left Sacroiliac Joint Dysfunction	5236	20%	20080211	
			Scoliosis	5299-5241	NSC		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Chronic LBP.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s non-traumatic low back condition began in 2005.  A lumbar spine MRI in May 2006 was normal.  There was no surgical indication.  During the 21 August 2007 MEB NARSUM examination, 6 months prior to separation, the CI reported daily LBP that intensified as the day progressed.  Bowel or bladder incontinence, impotence, weakness, and numbness were denied.  Physical examination revealed normal neurological testing and motor strength.  At the 23 October 2007 MEB physical therapy examination, 4 months before separation, repetitive thoracolumbar flexion was 90 degrees (normal) and combined range of motion [ROM] was 240 degrees (normal); painful motion present. 

At the 11 February 2008 VA Compensation and Pension (C&P) joints examination, 5 days after separation, the CI reported constant LBP down to the ankles.  Physical examination showed an antalgic gait and scoliosis.  Lumbar flexion was 50 degrees and combined ROM was 135 degrees; painful motion was elicited. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5236 (sacroiliac injury and weakness), citing spinal tenderness.  The VA also rated the condition 10%, using the same code (5236), based on the C&P joints examination, citing limitation of flexion.  In this case, LBP and sacroiliac joint dysfunction are closely related conditions.  In accordance with VASRD §4.66 (sacroiliac joint) which stipulates, “The lumbosacral and sacroiliac joints should be considered as one anatomical segment for rating purposes,” the panel considered the LBP and sacroiliac dysfunction together for fitness and rating determinations.

The panel agreed there was no limitation of motion to support a 10% rating as recorded in the STR and MEB physical therapy ROM examinations proximate to separation.  The 11 October 2007 MEB H&P examination (DD Form 2808) recorded “normal ROM.” Although the VA ROM examination documented lumbar flexion to 50 degrees and combined ROM of 135 degrees, the panel considered this examination an outlier that did not support the severity of the pathology.  There was sufficient evidence of spinal tenderness and painful motion IAW VASRD §4.59 to support a 10% rating.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, or documentation of intervertebral disc syndrome with incapacitating episodes to support a higher rating under that alternate formula. After due deliberation, considering all 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 20170206, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR, 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