RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04577
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090207

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Health Care Specialist, 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 - 20081022	VARD - 20090422	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5299-5237	10%	Spondylolysis and Spondylolisthesis, Thoracolumbar Spine	5239	10%	20081211	
Eczema	Not Unfitting	Chronic Contact Dermatitis	7806	10%	20081211	
Septorhinoplasty	Not Unfitting	S/P Nasal Fractures, S/P Septorhinoplasty, Deviated Nasal Septum, Allergic Rhinitis	6522-6502	0%	20081211	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in January 2006 after falling down stairs.  X-rays of the back revealed bilateral L5 pars interarticularis fractures with anterolisthesis (slippage) of L5 on S1.  She was evaluated and determined not to be a surgical candidate.  

The 30 October 2008 MEB NARSUM examination, 4 months prior to separation, noted complaints of 3/10 low back pain, but with extreme activity, her pain rapidly increased to 9/10.  Physical examination showed normal strength, muscle bulk and coordination.  Range of motion (ROM) testing showed flexion of 90 degrees (normal) and combined ROM of 235 degrees (normal 240), after repetition.  The examiner noted that “applying DeLuca's considerations, it was felt that she would lose approximately 5 degrees in forward flexion and extension.”  

At the 11 December 2008 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported chronic 8/10 low back pain which did not affect her ability to work.  She could not lift over 20 pounds and avoided repetitive bending activities and sit-ups.  She claimed one incapacitating episode of lumbar pain during the 12 months prior to the examination, lasting 3 days.  Physical examination showed normal gait.  Thoracolumbar spine examination showed no tenderness, abnormal spinal contour, muscle spasm or guarding.  Goniometric ROM testing showed flexion of 80 degrees and combined ROM of 230 degrees.  Repetitive motion elicited pain at the limit of lumbar flexion, but there was no additional limitation due to pain, fatigability or incoordination.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5299-5237 (lumbosacral strain), citing additional functional limitation of 5 degrees of forward flexion.  The VA rated the back condition 10%, coded 5239 (spondylolisthesis or segmental instability), based on the C&P examination, citing forward flexion of the thoracolumbar spine at 80 degrees.  

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 examinations proximate to separation.  There was no muscle spasm or guarding that resulted 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 which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of a higher rating under that alternate VASRD 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 Conditions:  Eczema and Septorhinoplasty.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  Neither of the conditions were profiled, implicated in the commander’s statement, or judged to fail retention standards.  There was no performance-based evidence from the record that either of the conditions 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 either of the contended conditions, so no additional disability ratings are 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 eczema and septorhinoplasty conditions, the panel recommends no change from the PEB determinations 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:

AR20180015225, XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	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.