RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02380
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20051002

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Operating Room Specialist, medically separated for “chronic back pain, due to scoliosis, without neurologic abnormality” with a disability rating of 10%.  

CI CONTENTION:  “Scoliosis has progressively gotten worse with increased pain and causes limitations to everyday life.”  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 - 20050719	VARD - 20060118	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain, Due To Scoliosis, Without Neurologic Abnormality.	5299-5237	10%	Scoliosis, Thoracolumbar Spine	5299-5237	20%	20050918	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40% 	

ANALYSIS SUMMARY:  

Chronic Back Pain, Due To Scoliosis, Without Neurologic Abnormality.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in 2003 without specific trauma or injury.  At the 14 January 2004 primary care appointment, examination of the spine showed tenderness across multiple points.  Range of motion (ROM) was noted as full for forward flexion and extension, and limited for side bending to the right.  A diagnosis of mechanical back pain with muscle spasm due to scoliosis was rendered.  During the 29 February 2004 physical therapy visit, the CI reported mid‑back pain rated at 6/10 while at rest.  The examiner noted X-ray results showing a 32-degree Cobb angle and diagnosis of scoliosis.  Posture was abnormal due to the scoliosis, but gait was normal.  

At the 20 August 2004 spine clinic appointment, the CI complained of continued thoracic back pain that was controlled by rest, but not medication.  Physical examination revealed a normal gait and stance, but muscle spasms in the mid thoracic back along with abnormalities of the right thoracic prominence.  X-rays showed a T7-T12 right curve of 40.5 degrees and represented a distinct progression from the 32-degree angle from 15 months earlier.  The assessment was scoliosis with a progressive and painful thoracic curve.  The CI declined offers of spinal surgery.  

During the 25 August 2004 primary care visit, the examiner noted the scoliosis and pain on palpation at the right medial scapular region and mild muscle spasm of 2 degrees.  Thoracolumbar range of motion (ROM) measurements performed by physical therapy on 7 September 2004 recorded active flexion to 20 degrees (normal 90).  Tenderness was reported at the right upper-to-mid thoracic spine paraspinals and underneath scapular muscles.  At the 24 May 2005 spine clinic appointment, the orthopedic surgeon noted thoracic and thoracolumbar spine abnormalities.  X-ray studies showed 33 degrees of scoliosis of the thoracic spine, concaved to the left, and 27 degrees of scoliosis of the lumbar spine concaved to the right.  Bone density appeared normal.  

The 2 June 2005 MEB NARSUM examination, 4 months prior to separation, noted CI complaints of constant back pain, rated at 6/10, which increased to 8/10 with certain movements and activities.  She could no longer lift anything over 15 pounds and the pain was exacerbated with standing for longer than 60 minutes.  While orthopedic surgeons offered surgery to stop the increasing curvature, the CI had declined.  Physical examination showed a T7-T12 right curve and significant pain between the right scapula and spine.  Tenderness started at approximately T6 and extended down to T12, with obvious scoliosis during forward bending and tenderness in the right periscapular muscles as well as mild muscle spasms.  There was no lumbar spine tenderness, neurosensory deficits, or pathological reflexes.  X-ray studies showed a right thoracic curvature and a compensatory left lumbar curvature.  The examiner diagnosed chronic right upper back pain due to scoliosis, which was slowly getting worse.  At the 24 June 2005 MEB PT ROM study, 4 months prior to separation, after repetition, active thoracolumbar flexion was to 80 degrees (normal 90) with painful motion and a combined ROM of 220 degrees (240 normal).  

At the 18 September 2005 VA Compensation and Pension (C&P) evaluation, 1 month before separation, the CI reported a confirmed diagnosis of scoliosis and chronic, sharp back pain with a severity of 6/10 elicited by physical activity and relieved by rest; she denied any lost time at work due to incapacitation.  Physical examination showed a normal posture and gait as well as muscle spasms.  Thoracolumbar ROM, after repetition, recorded active flexion to 90 degrees with a combined ROM of 240 degrees (normal).  ROM was not limited by fatigue, weakness, lack of endurance or incoordination.  X-ray studies showed moderate thoracolumbar dextroscoliosis.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5299-5237 (lumbosacral strain), citing limitation of motion.  The VA rated the back condition 20%, coded 5299-5237 (lumbosacral strain), based on the C&P evaluation, citing muscle spasm with abnormal spinal contour such as scoliosis.  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) or combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the PT/MEB NARSUM examinations.  Although there was abnormal spinal contour, it was not a result of muscle spasms, and did not justify the next higher 20% rating.  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 pain condition.  
BOARD FINDINGS:  In the matter of the chronic back pain, due to scoliosis, without neurologic abnormality 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 20170413, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record  

AR20180005910, 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