RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2017-03267
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090827

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

CI CONTENTION:  “At the time of the decision, I was informed that the condition would only get worse over time.  I am in constant pain all the time and only get prescribed Ibuprofen or steroid shots.”  In his attached statement, the CI also requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20090721	VARD - 20100420	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5237	10%	Lumbar Arthropathy with Intervertebral Disc Desiccation	5243	10%	20091203	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s low back condition began in June 2007 while training, when he experienced extra back loading situations.  A lumbar MRI was completed 16 Mar 2008.  The radiologist's impression was multilevel (lumbar] spondyloarthropathy.  

The 18 June 2009 MEB NARSUM examination, 2 months prior to separation, noted complaints of back pain that kept him from performing his required duties, specifically because he couldn't stand or sit for prolonged periods of time and his back would begin hurting without provocation.  Physical examination showed muscle spasm, and a normal gait.  Thoracolumbar range of motion (ROM) measurements showed flexion of 80 degrees (normal 90) and combined ROM of 175 degrees (normal 240) after repetition, associated with painful motion.  There was no additional limitation after repetitive movement.  
 
At the 3 December 2009 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported back pain that was mildly incapacitating at times, but he did not use any aids, such as a cane, crutch, or walking.  He was able to walk the length of a mall (1/4 mile).  The examiner found no tenderness, muscle spasm and a normal gait.  Thoracolumbar ROM measurements showed flexion of 90 degrees and combined ROM of 240 degrees with pain at endpoints.  There was no additional limitation after repetitive movement.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5237 (lumbar spine strain), citing forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees and IAW VASRD.  The VA also rated the low back condition 10%, coded 5243 (intervertebral disc syndrome [IVDS]), based on the C&P examination, citing painful motion.  

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 NARSUM examination proximate to separation.  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 evidence of IVDS which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula for that condition.  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 low 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:

PD-2017-03267

AR20190010021, XXXXXXXXXXXX 

Dear XXXXXXXXXXX

	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.

Enclosure

PD-2017-03267