RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX		CASE: PD-2017-04385 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20051118

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Automated Logistical Specialist, medically separated for “low back pain (LBP)” with a disability rating of 10%.

CI CONTENTION:  No specific contention was made.  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 - 20050914	VARD - 20060314	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP	5237	10%	Lumbar Myositis	5237	20%	20060215	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

LBP. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s low back condition began at the end of July 2004 after lifting a box while in Iraq, when he felt and heard a crack in his back. At the time of the physical therapy (PT) appointment on 4 May 2005, 6 months prior to separation, the CI reported 9/10 LBP with radiation into the left lower extremity and knee. On examination there was tenderness of the lumbar paraspinal muscles bilaterally. Posture revealed decreased lumbar lordosis. Thoracolumbar range of motion (ROM) showed flexion of 40 degrees (normal 90) and extension of 10 degrees (normal 30). The CI was able to toe and heel walk; deep tendon reflexes were normal. A PT examination on 22 June 2005, 5 months prior to separation, the CI reported overall improvement in his ROM,

but with continued pain. Physical examination noted no change in active flexion since the prior PT examination.

The 3 June 2005 MEB NARSUM examination, 6 months prior to separation, noted complaints of back pain in the middle of his back radiating down his legs, particularly his left leg, extending as far as the knee. Physical examination showed tenderness in the mid-thoracic spine to lumbar spine with pain on forced flexion and extension of the upper back. Straight leg raise (SLR) testing was positive on the left at 45 degrees. The CI was able to toe and heel walk without evidence of weakness. Thoracolumbar ROM measurements performed by PT on 1 September 2005, 3 months prior to separation, showed flexion of 5 degrees and extension of 35 degrees with combined ROM of 130 degrees (normal 240) after repetition.  Painful motion was noted.

At the 15 February 2006 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported daily LBP, worse on bending, lying down (supine or prone) and prolonged driving. Pain was rated at 8-9/10 on average with flare-ups at 10/10, which occurred two to three times per week. The CI reported he had not missed work due to LBP. Physical examination showed the CI’s posture and gait were normal. Thoracolumbar ROM showed flexion of 45 degrees and combined ROM of 185 degrees with painful motion noted. There was paravertebral lumbar spasm extending from L3 to S1 levels with tenderness in the area. SLR testing on the right was positive.

MRI of the lumbar spine on 20 February 2006, 3 months after separation, revealed mild deviation of the lumbar vertebrae towards the left side. The vertebral bodies were preserved in height. The intervertebral discs had normal signal with no evidence of disc herniation or spinal stenosis. The conus medullaris was in normal position and showed normal signal intensity. The neural foramina were adequate in size.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the LBP 10%, coded 5237 (lumbosacral strain), citing tenderness over the lumbar spine and a ROM reported as flexion of 10 degrees and extension of 40 degrees, with measurements limited by pain. Using the same code, the VA rated the low back condition 20% based on the VA C&P examination, citing evidence of lumbar spasms, painful motion, and being additionally limited by pain upon repetitive movement of the thoracolumbar spine to 45 degrees of flexion.

The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees), as reported on the 4 May 2005 PT and VA C&P examinations. The panel noted that the limitation of thoracolumbar motion recorded in the MEB PT examination met the threshold for a 40% rating. In assigning probative value to these somewhat conflicting examinations, the panel noted that the 4 May 2005 PT measurements and VA C&P measurements were consistent with other proximate (pre-separation) examinations by primary care and PT, as well as the normal MRI findings. Therefore the panel placed greater probative value on the 4 May 2005 PT and VA examinations. 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 recommends a disability rating of 20% for the low back condition, coded 5237.

BOARD FINDINGS: In the matter of the low back condition, the panel recommends a disability rating of 20% coded 5237 IAW VASRD §4.71a. There are no other conditions within the panel’s scope of review for consideration.

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Low Back Pain	5237	20%	

The following documentary evidence was considered:

PD-2017-04385 

AR20190012730, XXXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXX

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs. 

PD-2017-04385