RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02712
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090226

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Infantryman, medically separated for “lumbosacral strain” with a disability rating of 20%.  

CI CONTENTION:  In addition to the back condition, the CI requested review of an additional condition 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 - 20081211	VARD - 20090429	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbosacral Strain	5237	20%	Degenerative Disc Disease (DDD) Lumbar Spine 	5234	20%	20090311	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Lumbosacral Strain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in September 2005 after doing sit-ups and worsened while deployed to Iraq in November 2006.  Radiographic studies showed scoliosis and disk protrusions at L4-5 and L5-S1.  The 21 August 2008 physical therapy (PT) range of motion (ROM) study, 6 months prior to separation,  showed 70 degrees of forward flexion (normal 90) and combined ROM of 210 degrees (normal 240) with end-range pain in all planes of motion.  During the 24 September 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported chronic lower back pain with occasional spasms and severe flares that would cause him to be “down” for up to a week.  He also reported shooting pains through his legs.  Physical examination revealed decreased ROM and tenderness.  

During the 30 September 2008 MEB NARSUM examination, 5 months prior to separation, the CI reported daily 2/10 low back pain which rose as high as 9-10/10 when it locked up.  Flares resulted from normal activities, averaged once a month and resulted in 3 to 4 days of severe pain.  The pain radiated down both hips and lateral anterior thighs.  He was able to stand without much pain, but prolonged sitting caused problems.  Physical examination showed a non-antalgic gait and no palpable spasm, but there was tenderness.  The CI was neurologically intact.  There was slight levo-scoliosis noted at full forward flexion and significant pain at end range of flexion and extension.  

During the 21 November 2008 PT examination there were no abnormal gait patterns, but the CI sat shifted to the left, unweighting his right buttocks and constantly shifted.  There was muscle guarding and spasm.  ROM testing showed flexion of 60 degrees (normal 90) and combined ROM of 155 degrees.  There was muscle fatigue with repeated ROM and exacerbation by pain with incoordination during flare-ups.  Muscle strength in the L4-5 distribution was decreased bilaterally to 3/5 with fasciculation and there was slight muscle weakness in the hip flexors.  The back pain affected all positions and made him unable to run.  

At the 11 March 2009 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported daily low back pain rated at 2-3/10 and flaring to 9-10/10 about once per month, with radiation at times to knee level.  He was not working and had no incapacitating episodes within the previous 12 months.  Physical examination showed normal ambulation without assistive devices, but there was tenderness and lumbar spine X-rays showed straightening consistent with muscle spasm.  ROM testing showed flexion of 70 degrees and combined ROM of 220 degrees with pain after repetition on flexion and rotation.  There was pain along L3-4 and L5 and also bilateral lower para spinous muscle soreness on palpation and they felt tense.  An MRI revealed DDD with disc bulging at L3-4, L4-5 and L5-S1.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 20%, coded 5237 (lumbosacral strain), citing forward flexion (not rounded) to 58 degrees, lower back spasms and tenderness.  The VA rated the back condition 20%, coded 5243 (intervertebral disc syndrome), based on the C&P examination, citing muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour.  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) and/or muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, as reported on the MEB NARSUM and VA C&P examinations.  There was no evidence of ankylosis to support the next higher rating of 40%.  There was no evidence of intervertebral disc syndrome which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under that alternate VASRD 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 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 20170318, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190007080, 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.