RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX		CASE: PD-2017-04310 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20070523

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

CI CONTENTION:  Review of all conditions requested. 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 - 20070220	VARD - 20070504	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5237	10%	Lumbar Spine Degenerative Disc Disease L5-S1 and Thoracic Spine Degenerative Spurring T8-9, T9-10	5243	10%	20070312	
Heat Stroke Without Recurrent Heat Injury	Not Unfitting	Recurring Heat Stroke	8999-8911	NSC	20070312	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

Chronic Back Pain. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began gradually in October 2005 during combat operations with no known trauma or precipitant. The CI was treated with multiple conservative modalities to include pain medications, chiropractic manipulation, physical therapy (PT), TENS therapy, trigger  point  injections,  and  extended  periods  of  activity  modification  without      symptom

improvement. MRI studies revealed endplate spurring of the thoracic spine and mild spondylotic changes of the lumbar spine.

The 31 January 2007 MEB NARSUM examination, 4 months prior to separation, noted complaints of chronic mid and low back pain. Physical examination showed mild tenderness of the lower thoracic and lumbar spine. Flexion, extension and side bends were reported as normal. The examiner referred to specialty consults with orthopedic spine and physical medicine services. Both examinations noted tenderness and full active range of motion (ROM) with pain on flexion.

Thoracolumbar ROM measurements performed by PT on 1 February 2007, 4 months prior to separation, showed flexion of 55 degrees (normal 90) and combined ROM of 175 degrees (normal
240) after repetition, with pain on ending of active ROM. Both an inclinometer and goniometer were used for measurements. During the same-day MEB examination (recorded on DD Forms 2807-1 and 2808), the examiner noted mild tenderness of the lower thoracic and lumbar spine.

At the 12 March 2007 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported constant pain rated at 4/10 which traveled to the right and left sides of the mid back. The CI denied any incapacitation. Physical examination showed a normal posture and gait and there was no evidence of radiating pain on movement and no tenderness or muscle spasms. ROM of the thoracolumbar spine was flexion of 70 degrees and combined ROM of 220 degrees with pain at end range of flexion with no additional limitation after repetitive use.

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 tenderness and combined ROM of 200 degrees. The VA also rated the back condition 10%, coded 5243 (intervertebral disc syndrome [IVDS)], based on the C&P examination, citing forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees and the combined ROM greater than 120 degrees, but not greater than 235 degrees.

The panel noted that the thoracolumbar motion values recorded at the MEB PT ROM examination met the threshold for a 20% rating, however the measurements were performed using both an inclinometer and goniometer and not just goniometric measurements as specified by the VASRD (§4.71a, Plate V). The panel also noted full ROM comments at the orthopedic and physical medicine appointments. The VA examination was more proximate to separation and compliant with VASRD rating guidelines. Therefore the panel placed greater probative value on the VA examination.

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 combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the VA examination. 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 IVDS 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: Heat Stroke Without Recurring Heat Injury. The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting. The contended condition was not profiled or implicated in the commander’s statement and did not fail retention standards. There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the

PEB fitness determination for the contended condition, so no additional disability rating is recommended.

BOARD FINDINGS: In the matter of the back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the contended heat stroke condition, the panel recommends no change from the PEB determination as not unfitting. 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-2017-04310 

AR20190012183, XXXXXXXXXXXXXXXXXXXXXXXX

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.