RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03236
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080227 

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

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 - 20080225	VARD - 20080305	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbosacral Strain	5237	20%	Lumbar Spine Degenerative Disc Disease L5-S 1 and Strain	5243	20%	20080108	
Hypothyroidism	Not Unfitting	Hypothyroidism	7903	10%	20080108	
Tension Headaches	Not Unfitting	Tension Headaches	8199-8100	0%	20080108	
Adjustment Disorder with Anxiety and Depressed Mood	Not Unfitting	Post-Traumatic Stress Disorder	9411	30%	20080108	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50% 	

ANALYSIS SUMMARY:  

Lumbosacral Strain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back condition began while deployed to Iraq from September 2004 through March 2005.  During this deployment he began to notice low back pain (LBP) with the wearing of equipment.  He again deployed to Iraq from July 2005 through January 2006 and noted progressive worsening of the LBP.  Lumbar spine X-rays in June 2006 were normal.  An MRI done in January 2007 noted mild spinal canal narrowing at the L5-S1 level due to degenerative disc disease.  There was no surgical indication.  Thoracolumbar range of motion (ROM) measurements performed by physical therapy (PT) on 26 June 2007, 8 months prior to separation, showed flexion of 50 degrees (normal 90) and combined ROM of 175 degrees (normal 240) after repetition, with painful motion.  

The 1 November 2007 MEB NARSUM examination, 4 months prior to separation, noted complaints of constant LBP, graded 5/10.  He reported worsening pain with prolonged standing or walking; with movement after a period of inactivity; with bending, lifting or carrying weight, or climbing stairs; and with impact activities.  Physical examination showed tenderness, but no muscle spasm.  The examiner referenced the PT ROM cited above.  Lumbar spine X-rays on 2 November 2007 were normal.  

At the 8 January 2008 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported experiencing LBP over the past 3 years, described as constant, crushing, aching, and sharp, with a severity of 7/1O, elicited by physical activity and relieved by medications.  The CI reported he could function with medication and there had been no periods of incapacitation which required bedrest.  Physical examination showed a normal gait.  Spinal curvatures were normal.  There was muscle spasm but no tenderness.  Thoracolumbar ROM was flexion of 50 degrees and combined ROM of 185 degrees after repetitive motion.  There was no additional loss of ROM with repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 20%, coded 5237 (lumbar spine strain), citing tenderness to palpation over the lumbar spine and a ROM to 52 degrees.  The VA also rated the low back condition 20%, coded 5243 (intervertebral disc syndrome), based on the C&P examination, citing forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees.  

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), as reported on the NARSUM and VA examinations.  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 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.  

Contended PEB Conditions:  Hypothyroidism; Tension Headaches; Adjustment Disorder with Anxiety and Depressed Mood.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled, implicated in the commander’s statement, or judged to fail retention standards.  Specifically, the psychiatric consult dated 19 July 2007 determined the mental health condition was not medically disqualifying.  Headaches were also determined to not be disqualifying at the 7 August 2007 neurology appointment. There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the low back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended hypothyroidism, tension headaches, and adjustment disorder with anxiety and depressed mood conditions, the panel recommends no change from the PEB determinations as not unfitting.  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 20170428, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180006224, 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