RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXX	CASE: PD-2017-03979
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20091207

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Light Wheeled Vehicle Mechanic, medically separated for “low back pain” with a disability rating of 10%.

CI CONTENTION:  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 – 20090903	VARD - 20100428	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Degenerative Joint Disease of the Lumbosacral Spine	5242	20%	20100122	
Parasomnia	Not Unfitting	Parasomnia	6899-6847	NSC	20100128	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 40%	
	
ANALYSIS SUMMARY:

Chronic Low Back Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI began experiencing back pain in February 2008 without any specific trauma or injury. Spine X-ray in March 2008 were normal, but an MRI in April 2008 revealed mild scattered degenerative disc disease and osteoarthropathy of the lumbar spine without evidence for impingement. Despite physical therapy and chiropractic treatments, the pain persisted. Thoracolumbar range of motion (ROM) measurements performed by physical therapy (PT) for the MEB on 12 May 2009, 7 months prior to separation, showed flexion of 80 degrees   (normal

90) and combined ROM of 175 degrees (normal 240), after repetition and with painful motion. The orthopedic MEB NARSUM examination, the next day, noted CI complaints of back pain, rated at 7/10, and increased to 9-10/10 with aggravation from standing over 15 minutes or sitting for 25-30 minutes. He also had occasional numbness over both legs all the way to the toes. Physical examination showed tenderness, but no muscle spasms, and the CI was able to do toe and heel raises and forward flex to 21 cm short of touching his toes. An MRI study on 17 May 2009 revealed minimal spondylotic changes of the spine with no significant canal or foraminal stenosis, and no significant disc protrusion or extrusion. Two days later, X-rays revealed very slight, mid to upper lumbar spine rotoscoliosis, concave to the right, for which no bony anatomic basis was evident; the lumbar spine was otherwise unremarkable.

During the 20 May 2009 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months before separation, the CI reported constant back pain. Physical examination revealed midline tenderness, but no discoloration, edema or step-offs. There was mild pain with forward bending and increased pain with extension. Straight leg raise testing was negative. On 22 June 2009, neurosurgery reviewed the STR and determined surgery was not indicated.

At the 22 January 2010 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported a dull constant “grinding” pain then a stabbing-stinging pain in the low back, rated at 7/10, but denied any incapacitating periods in the previous 12 months. Physical examination showed a slow, wide-based gait and the ability to heel and toe raise. There was no spinal contour abnormality, deformity, crepitation or tenderness. Due to subjective complaints of pain with spasm, ROM was only completed one time and showed flexion to 20 degrees with a combined ROM of 140 degrees. The examiner noted no weakness or guarding during ROM testing and that the back pain did not affect transferring.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the back condition 10%, coded 5237 (lumbar spine strain), citing forward flexion of 80 degrees and combined ROM of 177 degrees. The VA rated the back condition 20%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing loss of motion, pain on motion and degenerative findings. In assigning probative value to the somewhat conflicting examinations in evidence, panel members noted the MEB PT ROM examination was more consistent with outpatient notes and better reflected the anticipated severity based on clinical pathology. There was no record of recurrent injury or other development to explain the marked impairment reflected by the C&P ROM measurements, and while ROM limitations may have progressed over time, there was no evidence from which to conclude that the severity at separation approached that recorded by the VA. 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) and/or combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the MEB PT ROM study. 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 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 back condition.

Contended PEB Condition: Parasomnia. The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting. According to DoDI 1332.38 E5.1.2, sleepwalking and/or somnambulism are conditions which do not constitute a physical disability and are not ratable in the absence of an underlying ratable causative disorder. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is 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 parasomnia condition, the panel recommends no change from the PEB determination as the condition does not constitute a disability. Therefore, the panel agrees it cannot recommend it for additional disability rating. 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-2017-03979

AR20190010939, XXXXXXXXXXXXXXXXXXX 

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-2017-03979