RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04924
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20091016

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E4, Vehicle Mechanic, medically separated for “lumbosacral strain” with a disability rating of 10%.  

CI CONTENTION:  “There were injuries that were not included.”  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 - 20090825	VARD – 20100401 & 2010929	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbosacral Strain 	5237	10%	Lumbosacral Strain 	5010-5242	10%	20100611	
Bilateral Medial Epicondylitis 	Not Unfitting	Ulnar Neuritis (Right)	8616	NSC	STR	
Bilateral Wrist Tendonitis	Not Unfitting					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Lumbosacral Strain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI had a history of back pain dating back to June 2000, but the condition did not become significantly impairing until after a road march in October 2008.  An MRI in November 2008 documented multiple degenerative changes at L4-L5 and L5-S 1.  The 1 July 2009 MEB NARSUM examination, 4 months prior to separation, noted complaints of low back pain.  Physical examination showed normal ambulation.  There was lumbar and left sacroiliac joint tenderness and flattening of the normal lordotic curve, without evidence of muscle spasm or guarding.  Thoracolumbar range of motion (ROM) testing showed flexion of 90 degrees (normal) and combined ROM of 205 degrees (normal 240).  During the 30 July 2009 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported back pain requiring use of a back brace and was unable to sit or lie down for prolonged periods of time.  Physical examination showed the CI was unable to duck, heel or tip toe walk and could only forward flex to about 45 degrees with pain.  An STR entry by the MEB examiner the same date showed back tenderness and spasm.  

At the 11 June 2006 VA Compensation and Pension (C&P) muscle and nerve examination, 8 months after separation, the CI reported radiating low back pain and bilateral leg symptoms with decreased coordination, weakness, uncertainty of movement and increased fatigability.  Examination showed a normal posture, gait and spinal contour without muscle spasm or atrophy.  However, there was tenderness, guarding and painful back motion.  The ROM evaluation showed flexion of 60 degrees and combined ROM of 170 degrees.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5237 (lumbosacral strain), citing limited ROM and flattening of the normal lordotic curve without spasm.  The VA rated the back condition 10%, dual coded 5010-5242 (arthritis, due to trauma - degenerative arthritis of the spine), based on the C&P examination, citing limitation of motion.  The panel deliberated on the probative value of the somewhat disparate examinations in evidence and 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 MEB and VA examinations.  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 back condition, coded 5237.  

Contended PEB Conditions:  Bilateral Medial Epicondylitis and Bilateral Wrist Tendonitis.  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 any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the back condition, the panel recommends a disability rating of 20%, coded 5237 IAW VASRD §4.71a.  In the matter of the contended bilateral medial epicondylitis and bilateral wrist tendonitis, 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.  

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

CONDITION	VASRD CODE	PERMANENT RATING	
Lumbosacral Strain 	5237	20%	

XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified to 20% 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.

Sincerely,					       
						      					
Enclosure