RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX 	CASE:  PD-2017-04758
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050420

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E7, Health Care Specialist, medically separated for “chronic mechanical low back pain with L5 spondylolysis and sacroiliac arthritis, without neurologic abnormality” with a disability rating of 20%.  

CI CONTENTION:  “Reconsidering the long term effects of orthopedic injuries to include previous rating as well as femur pain due to bilateral fractures resulting from a 140 foot fall during a rescue mission from a UH-60/Blackhawk.  My pelvis sacra lilac bolts.”  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 Medical Evaluation Board (MEB), but determined by the Physical Evaluation Board (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 - 20050301	VARD - 20051018	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Mechanical Low Back Pain…	5299-5237	20%	Residuals, Status Post Open Reduction and Internal Fixation, Pelvis to Include Sacral Fracture	5236	0%	20050314	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Mechanical Low Back Pain (LBP).  According to the service treatment record and MEB narrative summary (NARSUM), the CI sustained a sacral fracture along with other injuries in July 1996 after falling while performing a rescue maneuver from a helicopter.  He underwent back surgery with an open reduction and sacral bolt fixation plus anterior external fixation on the pelvis; the sacral hardware was removed in 1997.  By 2004, the back pain was worsening with increased activities, and radiographic imaging showed spondylosis, and some degenerative changes of the sacroiliac (SI) joints.  The MEB forwarded spondylolysis of L5 vertebrae, osteoarthritis of the SI joint, and mechanical lumbar back pain.  The 9 September 2004 physical therapy examination, 7 months prior to separation, noted that CI reports of worsening pain from prolonged standing, sitting, and ruck marching had not limited him from participating in all activities.  Physical examination showed a normal gait and lumbosacral and sacrum tenderness.  The lumbosacral spine demonstrated “full range of motion” (ROM), with no painful motion.  

During the 7 January 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months before separation, the CI reported he had broken his sacrum and had LBP, along with noting other bodily ailments.  The examiner noted leg pain with activity and some limiting ROM of the legs, hips, and back, and wrote “see ortho notes,” however, there were no orthopedic treatment entries in evidence for review.  The MEB NARSUM examination, 3 days later, noted complaints of pain occurring sometimes at night especially when sleeping in a wrong position.  Pain occurred with prolonged running, heavy lifting (such as carrying a rucksack), and wearing a flak vest.  The pain did not radiate down either of the lower extremities, and the CI denied any weakness or numbness.  Physical examination showed lumbar spine tenderness, and the examiner stated that he “could flex his lower spine to approximately 60 degrees forward flexion [normal 90] without much difficulty.”  There was more pain with extension to approximately 25 degrees (normal 30), and combined range of motion ROM was 205 degrees (normal 240).  

At the 14 March 2005 VA Compensation and Pension (C&P) examination, 1 month prior to separation, the CI reported aching and cramping LBP, rated at 7/10, which occurred 3 times and lasted approximately 2 hours each time.  The pain was elicited by physical activity, sleeping wrong, or sometimes without a specific cause, but he denied any physician recommended bed rest.  Functional impairment included difficulty with bending, sleeping, and prolonged standing, and he missed work approximately twice a month.  Physical examination showed normal posture and gait with no evidence of radiating pain on movement, muscle spasm, or tenderness.  Thoracolumbar ROM measurements revealed active flexion to 90 degrees, and combined ROM of 240 degrees, with no pain, fatigue, weakness, lack of endurance, or incoordination, and no evidence of intervertebral disc syndrome (IVDS).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 20%, analogously coded as 5299-5237 (lumbosacral strain), citing thoracolumbar forward flexion to 60 degrees.  The VA rated the low back condition 0%, coded 5236 (sacroiliac injury and weakness), based on the C&P examination, citing thoracolumbar forward flexion greater than 85 degrees or combined ROM greater than 235 degrees.  Panel members noted that in accordance with VASRD §4.66 (sacroiliac joint), “the lumbosacral and sacroiliac joints should be considered as one anatomical segment for rating purposes,” and thus the LBP and sacroiliac dysfunction were considered together.  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 NARSUM examination.  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 LBP.

BOARD FINDINGS:  In the matter of the low back 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 no modification or re-characterization of the CI’s disability and separation determination.  
The following documentary evidence was considered:

PD-2017-04758

[AR NUMBER], XXXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXX

	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.

Enclosure

PD-2017-04758