RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02985
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050408

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Unit Supply Specialist, medically separated for “low back pain (LBP)” with a disability rating of 10%.  

CI CONTENTION:  Review of all conditions requested.  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 - 20050214	VARD - 20060221	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP Secondary to Grade II Spondylolisthesis L5/S1	5239	10%	Spondylolisthesis, L5/S1	5239	20%	20050906	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic LBP...  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back condition began in late 1997 after sustaining a fall.  Following years of non-surgical treatment, spinal X-rays and a bone scan revealed a bilateral pars interarticularis fracture at L5 with associated Grade I forward slippage of L5-S1.  His treatments remained conservative.  An 8 September 2004 orthopedic examination, 7 months prior to separation, noted full range of motion (ROM) of the lumbar spine as well as a non-antalgic gait.  

The 18 January 2005 MEB NARSUM examination, 3 months prior to separation, noted complaints of LBP rated as 3/10 at rest and 7/10 during flare-up exacerbations, which occurred seven times per month.  He endorsed that his work duties which entailed lifting, bending, and squatting, were significantly limited,   Additionally, he noted having difficulties performing soldierly duties such as 3-5 second rushes, low and high crawling, running, ruck marching, and jumping; however, he also noted that he was able to perform all activities of daily living without complications.  His physical examination (PE) revealed a normal stance and gait.  The thoracic spine was non-tender and had full ROM.  The lumbar spine had a decrease in normal curvature and mild tenderness was noted over the paravertebral musculature.  Spinal (lumbar) ROM revealed forward flexion to 70 degrees (normal [thoracolumbar] is 90) and combined ROM of 155 degrees (normal [thoracolumbar] is 240).  

At the 6 September 2005 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported constant LBP.  The PE revealed lumbosacral spasms.  Spinal (lumbar) ROM forward flexion was 60 degrees with repetition and combined ROM was 210 degrees with painful motion noted. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5239 (spondylolisthesis), citing flexion limited to 70 degrees and paraspinal tenderness.  Utilizing the same VASRD code, the VA rated the low back condition 20%, based on the C&P examination, citing repetition of movement, which resulted in rapid decrease of flexion to 60 degrees with muscle spasm.  Panel members first agreed that the greatest degree of probative value be apportioned to the NARSUM examination secondary to its close reference to the date of separation.  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) and combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the MEB examination.  There was no 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 no evidence to support a rating higher than the 10% adjudicated by the PEB.

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 20170329, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190008739, XXXXXXXXXXXXXXXXXX 

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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.