RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxxxxxxxxxxxxxxxxxx 	CASE:  PD-2017-03861
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090822

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

CI CONTENTION:  The CI 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 - 20090529	VARD - 20100216	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5237	20%	Lumbar Strain	5237	10%	20090928	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Low Back Pain.  The MEB forwarded three conditions of the thoracic and lumbar spine as not meeting retention standards:  low back pain, thoracic compression fractures and lumbar compression fracture.  The PEB combined these three diagnoses under a single disability rating, coded 5237 (lumbosacral strain), and rated 20%.  In this case the low back pain and thoracic and lumbar compression fractures are associated diagnoses and not separable for fitness or rating.  According to current VASRD guidelines for rating the spine (in effect on the date of the CI’s military separation), the thoracolumbar spine is rated as a single unit.  

According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back pain began in June 2007 after he was involved in a motor vehicle accident and suffered compression fractures of the T11-L1 and T4-T6 vertebral bodies.  Thoracolumbar range of motion (ROM) measurements performed by physical therapy (PT) on 19 August 2008, 12 months prior to separation, showed flexion of 85 degrees (normal 90) and combined ROM of 210 degrees (normal 240), after repetition and with ROM limitations due to pain.  At the pain management appointment on 10 November 2008, 9 months before separation, the CI reported continuous low back pain.  The provider noted significant point tenderness and trigger points over the lumbar spinous processes and along the top of both buttocks.  Tenderness was also noted across both shoulders and into the trapezius muscles bilaterally.  

The 20 January 2009 MEB NARSUM examination, 7 months prior to separation, noted CI complaints of lower back pain for which he consistently used a cane to alleviate discomfort while walking.  He did not having any radicular pain or paresthesias, and denied bowel or bladder dysfunction.   Physical examination showed an antalgic gait, with use of a cane, but no spinal deformity or abnormal contour.  There was active guarding and spinal and paravertebral tenderness from T7-T10 and L3-L5.  Lower extremity strength and reflexes were normal.  The examiner repeated the goniometric ROM measurements from the 12 August 2008 PT study, noting they were consistent with the examination that day.  The CI was unable to touch his toes, but could reach to the distal shins.  

At the 28 September 2009 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported constant moderate lower back pain, exacerbated by physical activity and stress, but denied any incapacitation.  He used a cane for ambulation as it offered support to alleviate the back pain.  Physical examination revealed a normal gait and posture, with no spinal contour, muscle spasm, guarding of movement, or abnormal muscle tone.  Mild tenderness was noted at upper lumbar paraspinal muscles and also between the shoulder blades. Examination maneuvers to elicit radicular symptoms were negative, and thoracolumbar ROM showed flexion of 90 degrees and combined ROM of 240 degrees, after repetition.  Joint function of the spine was additionally limited by pain after repetitive use.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 20%, coded 5237, citing guarding severe enough to result in an abnormal gait.  The VA rated the low back condition 10%, coded 5237, based on the C&P examination, citing painful motion.  Panel members agreed there was no limitation of thoracolumbar spine motion to support a 10% rating, however the MEB NARSUM examination noted the presence of guarding associated with an abnormal gait, and thus a 20% rating was warranted.  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 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.  

AR20190010899, XXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXX:

	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.