RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02132
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070724

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Bradley Fighting Vehicle System Maintainer, medically separated for “mechanical low back pain, without motor neurologic deficit” with a disability rating of 10%.  

CI CONTENTION:  His back condition was more severe than he was told.  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 - 20070621	VARD - 20080229	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Mechanical Low Back Pain	5237	10%	Degenerative Disc Disease, Lumbar	5243	0%	20080114	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Mechanical Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in March 2003 after a fall.  A lumbar MRI was essentially normal with possible early annular bulges at the L4-L5 and L5-S1 without herniation or stenosis.  The orthopedic surgeon determined the condition to be nonsurgical.  An examination on 2 April 2007 noted the CI had muscle spasms in his lower back, but straight leg raise testing (to determine nerve root irritation) was negative bilaterally.  

The physical therapy range of motion (ROM) study on 4 May 2007 showed active flexion of 40 degrees (normal 90) and combined ROM of 170 degrees (normal 240), limitations were due to pain.  The flexion and extension measurements were assessed with an inclinometer, but lateral flexion and rotation measurements were assessed with a goniometer.  Although there was localized tenderness, there was no abnormal gait due to muscle spasm or guarding and no abnormal spinal contour such as scoliosis, reversed lordosis or abnormal kyphosis.  The 17 May 2007 MEB NARSUM examination, 2 months prior to separation, noted complaints of chronic lower 4/10 back pain.  Physical examination incorporated the physical therapy findings above.  Sensation, motor strength and reflexes were normal.   

At the 14 January 2008 VA Compensation and Pension (C&P) examination, 6 months after separation, the CI reported a constant lower back pain which increased with prolonged standing, walking, bending, lifting and positioning.  The pain frequently radiated to the lower legs and feet.  Physical examination showed a normal gait without tenderness, loss of normal curvature of the spine, limb dysfunction or atrophy.  The ROM study revealed no evidence of discomfort or loss of mobility.  Flexion was 90 degrees and combined ROM was 240 degrees.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5237 (lumbosacral strain), citing ROM limited by pain and spasm.  The VA rated the back condition 0%, coded 5243 (intervertebral disc syndrome [IVDS]), based on the C&P examination, citing no spasm, tenderness or altered gait and full painless ROM without functional loss due to pain, weakened movement, excessive fatigability with use, incoordination or flare-ups with repetitive motion.  

The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees) as reported on the physical therapy examination and as incorporated in the MEB NARSUM examination.  Members noted the physical therapy measurements, 2 months prior to separation, were more proximate to separation than the VA measurements, 6 months after separation, and thus held more probative rating value.  There was no documentation of IVDS with incapacitating episodes which would provide for a higher rating under that formula.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the back condition, coded 5237.  

BOARD FINDINGS:  In the matter of the back condition, the panel recommends a disability rating of 20%, coded 5237 IAW VASRD §4.71a.  There are 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 the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Mechanical Low Back Pain	5237	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170327, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180010648, 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