RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2017-03003
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051008

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Automated Logistical Specialist, medically separated for “chronic low back pain” with a disability rating of 10%.  

CI CONTENTION:  “Please review all conditions.”  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 – 20050829	VARD – 20050921	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Degenerative Disc Disease	5243	20%	20050725	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Low Back Pain (LBP).  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition began in October 2004 after falling off a 5-ton truck.  On 19 January 2005 she reported being in a motor vehicle accident a day earlier and hitting her left side against the car door, which caused pain on the left side of the body, mainly to the shoulder and rib cage area.  Treatment consisted of a nonsteroidal anti-inflammatory drug and a muscle relaxer.  X-rays of the lumbosacral spine and left hip dated 31 March 2005 were normal.  Another examination that day noted her gait was normal.  There was straight alignment of the spine and movements were smooth and easy.  At a physical therapy clinic visit on 20 April 2005 the CI stated her main pain was at the sacroiliac joints, the left hip distally, and superficial to the iliac crest.  She had full range of motion (ROM) and strength appeared decreased in the left lower extremity.  The left anterior iliac crest was tender anteriorly and posteriorly.  Lumbar exercises and hip strengthening were instituted.  A note dated 26 May 2005 indicated her pain was from L1-L5 in the midline.  The CI underwent traction twice, which made the pain worse, and also had treatments including stretching, pool therapy, electrical stimulation, manipulation, and medication.  An MRI of the lumbar spine dated 6 June 2005 showed minimal degenerative disc disease at L3-L4 and L1-L2 with no evidence of focal disc protrusion or nerve root compromise.  An epidural steroid injection was given on 13 July 2005.  

The 7 July 2005 MEB NARSUM examination, 3 months prior to separation, noted complaints of daily LBP with a pain level of 7/10.  Physical examination of the lumbar spine showed no gross spinal abnormalities.  There was tenderness over the lower spinous processes.  Muscle spasms were noted over the lumbar paraspinals.  Bilateral straight leg raise testing (to determine nerve root irritation) was negative for radicular symptoms.  Patrick-Faber testing (to determine hip and/or sacroiliac pain) was negative on the left and right.  Neurosensory testing was intact to light touch, pinprick, vibration and proprioception.  Thoracolumbar ROM measurements showed flexion of 75 degrees (normal 90) and combined ROM of 200 degrees (normal 240) after repetition.  During the 13 July 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), the CI reported constant back pain from the middle to the lower back.  Physical examination revealed her lumbar spine was tender.  

In a note to the PEB on 19 August 2005 the CI reported she had a second epidural steroid injection.  X-rays dated 12 September 2005 showed narrowing of the lumbosacral junction disc space probably on the basis of a transitional vertebral body at S1.  No acute fractures or dislocations were seen.  There was preservation of the L1 through L5-S1 disc spaces and no gross abnormalities.  At an examination on 8 October 2005, flexion of the lumbar spine was 50 degrees with an annotation of -45 degrees and thoracic spine flexion was 20 degrees.  Her gait was within normal limits.  

At the 4 November 2005 VA Compensation and Pension (C&P) examination, one month after separation, the CI reported daily LBP with a severity of 7/10 with lifting, running, standing, and walking; however, the pain was stable with rest.  Physical examination of the lumbosacral spine was reported as flexion 50 degrees with 45 degrees deficit, extension 20 degrees with 15 degrees deficit, lateral motion 20 degrees right and left with 20 degrees deficit, and rotary motion 25 degrees right and left.    Thoracic spine flexion was 20 degrees and extension minus 10 degrees.  There was tenderness from T6-T12 and tenderness over the L1-T5 interspace with 2+ paraspinous muscle spasm.  Straight leg raise testing was negative and her gait was normal.  Neurologic evaluation was normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5237 (lumbosacral strain), citing normal imaging, non-deforming muscle spasm, no radiculopathy, and flexion limited to 70 degrees.  The VA rated the back condition 20%, analogously coded 5243 (intervertebral disc syndrome [IVDS]), based on the C&P examination, citing lumbar spine flexion was 50 degrees, which is greater than 30 degrees but not greater than 60 degrees.  

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) as reported on the MEB NARSUM examination.   The VA examination, based on an earlier examination’s measurements, were apparently of the lumbar spine at 50 degrees, despite the annotation of -45 degrees, and of the thoracic spine at 20 degrees.  The panel interpreted those results as a thoracolumbar measurement of 70 degrees.  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 an 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 concluded there was insufficient cause to recommend a change in the PEB adjudication for the back condition.  

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 20170330, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

PD-2017-03003

AR20190009907, XXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXX

	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-2017-03003