RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2017-03972
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090427

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E-1, Infantryman, medically separated for “chronic low back pain” with a disability rating of 10%.  

CI CONTENTION:  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 - 20090211	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: NA	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI developed low back pain in October 2006 attributed to protracted load-bearing while deployed to Afghanistan.  The pain persisted after redeployment and imaging (MRI) demonstrated multilevel degenerative disc disease (L3-S1 with herniation at L5-S1, no note of neural compromise).  There was intermittent pain radiation and distal sensory complaints (bilateral), but multiple neurological examinations were normal and orthopedics opined that surgery was not indicated.  There were some earlier STR provider entries that documented moderate range of motion (ROM) limitation, but all later entries indicated grossly normal ROM (some specifying painful motion).  There was also evidence of normal gait and spinal contour with no contrary entries, and no record of incapacitating episodes.

The 9 October 2008 MEB NARSUM examination, 7 months prior to separation, documented persistent low back pain, rated at 6-7/10, that prohibited running and load-bearing and limited walking to about a mile.  The physical examination made note of nonspecific ROM limitation and spasm, but referenced the MEB’s DD Form 2808 physical examination (21 October 2008), which  did not note any positive lumbar or neurological findings.  Goniometric thoracolumbar ROM measurements for the MEB were conducted by physical therapy (PT) on 20 November 2008, 5 months prior to separation.  The PT examiner charted flexion to 65 degrees (normal 90) and combined ROM of 195 degrees (normal 240), specifying painful motion but no ROM degradation with repetition.  The examiner noted tenderness without spasm and documented a normal gait and spinal contour.

There was no VA examination in evidence that was temporally proximate to separation.  However, a VA Compensation and Pension (C&P) examination of 2 February 2011 (20 months after separation) documented that the CI was a full-time construction worker and recorded ROM measurements of flexion to 70 degrees and combined 200 degrees.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the lumbar spine condition 10%, coded 5237 (lumbosacral strain), referencing the PT ROM measurements and citing all applicable provisions of the VASRD.  The remote C&P evidence yielded a subsequent VA rating (effective 25 May 2011) of 10%.  Panel members agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) and combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the PT 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 intervertebral disc syndrome with incapacitating episodes that 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 lumbar spine condition.  

BOARD FINDINGS:  In the matter of the lumbar spine 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 that there be no modification or re-characterization of the CI’s disability and separation determination.  

PD-2017-03972

AR20190010944, XXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXX

	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-2017-03972