RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX		CASE: PD-2017-03856 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20070228

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E3 , Infantryman, medically separated for “chronic low back pain [LBP]” with a disability rating of 10%.

CI CONTENTION: The applicant makes no contentions. 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 - 20070111	VARD - 20060629	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP	5237	10%	Herniated Nucleus Pulposus of L4-5 with Spinal Stenosis, Anterolisthesis L5-S1	5238	20%	20060613	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 30%	

ANALYSIS SUMMARY:

Chronic LBP. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back condition began in March 2004 while doing a 5K road march carrying 200 pounds of gear and doing fire missions. Treatment was conservative (profile, physical therapy and medication) without relief. The pain was aggravated by prolonged sitting, standing, walking, running, bending, reaching, and lifting; pain improved with rest. The CI was asked to wear a lumbosacral brace and placed on Mobic, neither of which were tolerated. Radiographs of the lumbar spine revealed bilateral spondylolysis of L5, resulting in a Grade I anterolisthesis L5 on S1, most pronounced in extension and corrected slightly with flexion. An MRI of the lumbar spine showed a Grade 1 anterolisthesis of L5-S1 and a small herniated nucleus pulposus of L4 and   L5

with mild central canal stenosis and foraminal narrowing bilaterally. Surgery was not recommended.

At the 13 June 2006 VA Compensation and Pension (C&P) examination, 8 months before separation, the CI reported the pain progressively worsened. Flare-ups were reported as daily and aggravated by sitting, bending, twisting, and walking (especially up hill). There were no bowel or bladder complaints. Physical examination (PE) showed an antalgic gait with a slight limp on the left. Spinal curvature showed moderate lumbar lordosis. No spasm, atrophy, guarding,  or weakness was noted. There was pain with motion and tenderness was moderate. The examiner noted that muscles spasm, localized tenderness or guarding were severe enough to be responsible for abnormal spinal contour. Thoracolumbar spine range of motion (ROM) measured using a goniometer showed flexion at 80 degrees (normal 90) and combined ROM of 200 degrees (normal 240).

The 24 September 2006 MEB orthopedic NARSUM examination, 5 months prior to separation, noted back pain was slight but constant, limiting the CI’s ability to fulfill his military occupational specialty duties. PE showed the CI was able to rise from a chair in a sitting position without any apparent discomfort. ROM showed flexion at 75 degrees and combined ROM at 195 degrees. ROM was decreased secondary to pain. Diffuse tenderness was noted over the L2 to S1 without spasm. Strength showed 5/5 in all major muscle groups of the lower extremities. The CI was able to squat and heel and toe walk. Straight leg raise testing was equivocal bilaterally. A neurological examination was normal.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the chronic LBP 10%, coded 5237 (lumbosacral strain), citing motion limited by pain, and tenderness with no spasm or deformity. The VA rated the herniated nucleus pulposus of L4- 5 with spinal stenosis anterolisthesis L5-S1 condition 20%, coded 5238 (spinal stenosis), based on the C&P examination, citing evidence of pain with guarding severe enough to cause an abnormal gait. Subsequent VA records documented back surgery in 2010 and continued post-separation worsening.

The panel deliberated on the probative value of the examinations in evidence. The orthopedic NARSUM was comprehensive and closest to separation and therefore had the highest probative value for rating at 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) 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 noted in the NARSUM examination, 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 insufficient cause to recommend a change in the PEB adjudication for the chronic low back condition.

BOARD FINDINGS: In the matter of the chronic low back condition and IAW VASRD §4.71, 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.

PD-2017-03856

AR20190010897, XXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXX

	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-2017-03856