RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03228
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080812

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Metal Worker, medically separated for “mechanical low back pain” with a disability rating of 20%.  

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’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 - 20080430	VARD - 20081212	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Mechanical Low Back Pain…	5299-5237	20%	Compression Fracture of L1	5235	10%	20080903	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Mechanical Low Back Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s low back condition began in 2002 after falling out of a window.  He was diagnosed with an L1 compression fracture and prescribed a back brace.  He returned to full duty and was asymptomatic until June 2007 after he jumped off a truck.  An MRI in September 2007 showed disk disease at L4-L5, and L5-S1, and an old compression fracture at L1; he was not a surgical candidate.

During the 15 November 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 9 months prior to separation, the CI reported back pain accompanied by numbness and tingling in his legs and feet.  Physical examination revealed a positive bilateral straight leg raise test and tenderness along the paraspinal muscles, but no spasms. 

The 18 March 2008 MEB NARSUM examination, 5 months prior to separation, noted complaints of daily back pain and transient radicular symptoms that were primarily positional, especially while bending with straight legs.  Physical examination reflected the findings of the MEB examination and also indicated no increased pain, fatigue, weakness, or decreased endurance or incoordination related to repetitive range of motion (ROM).  Measured ROM was painful and showed forward flexion to 46 degrees (normal 90), and extension to 25 degrees (normal 30).  

At the 3 September 2008 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported chronic back pain that responded well to medication.  Physical examination noted ambulation with a cane and muscle spasms.  Strength was decreased in both lower extremities, but there was no muscle atrophy or other abnormalities noted.  Flexion was to 80 degrees and extension to 25 degrees, with a combined ROM of 205 degrees (normal 240).

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 20%, analogously coded 5299-5237 (lumbosacral or cervical strain), citing pain-limiting forward flexion of 46 degrees.  The VA rated the low back condition 10%, coded 5235 (vertebral fracture or dislocation), based on the C&P examination, citing flexion of 80 degrees without pain or spasm.  Members 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 combined ROM greater than 120 degrees but not greater than 235 degrees, as reported on the NARSUM examination.  There was no evidence of intervertebral disc syndrome which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of a higher rating under the alternate VASRD formula for that condition.  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 low back condition.   

BOARD FINDINGS:  In the matter of the mechanical low back pain 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 20170411, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Record  

AR20180009123, 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