RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXX	CASE: PD-2017-02752
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20070116

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E7, Mechanical Maintenance Supervisor, medically separated for “low back pain” with a disability rating of 10%.

CI CONTENTION:  No specific contention was made.  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 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 - 20061026	VARD - 20070629	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5237	10%	Low Back Condition	5242	20%	20070501	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 80%	

ANALYSIS SUMMARY:

Low Back Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition began after a fall in April 2005 while deployed. An (MRI) demonstrated degenerative disc disease at L3/4, L4/5 and L5/S1 with “mild” bilateral foraminal narrowing. Multiple neurological examinations were normal, and surgery was discussed but deferred after normal electrodiagnostic studies. Provider entries in the STR documented nonspecific range of motion (ROM) limitation with no indication of severe limitation. There was occasional note of gait disturbance without specific correlation with spasm or guarding, but the majority of examinations recorded a normal gait. There was no STR indication of an abnormal spinal contour or documentation of incapacitating episodes.

The 25 August 2006 MEB NARSUM examination, 5 months prior to separation, documented persistent 8/10 low back pain that interfered with driving and heavy lifting. The physical examination recorded a normal gait and no evidence of abnormal spinal contour, but there was tenderness   and   spasm   without.      The   NARSUM   addended   formal   thoracolumbar  ROM

measurements conducted by physical therapy (PT) on 18 August 2006, which showed flexion of 80 degrees (normal 90) and combined ROM of 215 degrees (normal 240) with painful motion.

The 1 May 2007 VA Compensation and Pension (C&P) examination, 3 months after separation, documented nonspecific back pain causing mild interference with some daily activities. The physical examination recorded a normal gait and no evidence of abnormal spinal contour, tenderness or spasm, but there was guarding. The VA ROM measurements were specifically annotated as “affected spine segment: lumbar,” indicating that they were segmental rather than full thoracolumbar measurements as specified by VASRD §4.71a (Plate V). The examiner documented flexion to 60 degrees (normal for segmental lumbar) and normal ROM (measurements not given) in all other planes, specifying painful motion but no degradation with repetition.

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 tenderness and pain- limited flexion to 80 degrees. The VA rated the condition 20%, coded 5242 (degenerative arthritis of the spine), based on the VA C&P examination. The VA rater treated the C&P ROM findings as ratable thoracolumbar measurements, citing flexion greater than 30 degrees but not greater than 60 degrees. The panel considered whether the C&P evidence was sufficiently probative to support a 20% recommendation as conferred by the VA, but agreed it was not. The VA examiner may well have made the appropriate thoracolumbar measurements and erroneously labeled them as segmental, but significant speculation was required to reach that conclusion. Furthermore the designation of all other planes as normal rather than providing the measured values was also questionably compliant with VASRD §4.46 (accurate measurement). The panel therefore assigned determinant probative value to the MEB PT ROM evidence. Panel members agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees), as reported in the MEB PT examination. There was insufficient evidence of 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. 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 20170307, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

	PD-2017-02752
AR20190015552, XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX

	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.

	PD-2017-02752