RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX  	CASE:  PD-2017-04994
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090323

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Electronic Warfare Intercept System Repairer, medically separated for “lumbosacral strain” with a disability rating of 20%.   

CI CONTENTION:  In addition to the back condition, the CI requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 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 - 20081211	VARD - 20090514	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbosacral Strain	5237	20%	Thoracolumbar Degenerative Disc Disease with Sciatica and Scoliosis	5242	40%	20081030	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60% 	

ANALYSIS SUMMARY:  

Lumbosacral Strain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in July 2004 after unloading heavy equipment from an aircraft while deployed to Afghanistan.  She was involved in a motorcycle accident on 6 June 2008 which aggravated her back.  Lumbar spine X-rays in June 2008 were normal, but an August 2008 MRI showed disc protrusions at T10-11, L4-L5 and L5-S1 with mild to moderate effacement of the spinal canal.  There were also mild degenerative facet joint changes at L5-S1.  

At the 30 October 2008 VA Compensation and Pension (C&P) examination, 5 months before separation, the CI reported intermittent pain in the lumbar spine with radiation of pain to the  buttocks and right hip, and numbness of the left hip.  Physical examination showed an antalgic gait with normal spinal curvatures.  There was no tenderness or muscle spasm.  Thoracolumbar range of motion (ROM) measurements showed flexion of 20 degrees (normal 90) and combined ROM of 100 degrees (normal 240) with pain.  There was no additional loss of ROM with repetitive use.  Lower extremity strength, sensation, and reflexes were normal. 

The 31 October 2008 MEB NARSUM examination, performed 1 day after the C&P examination, noted complaints of daily, constant, dull lower back pain that increased during the day with lifting equipment, walking greater than a quarter mile or standing in formation.  Physical examination showed tenderness, spasms, abnormal spinal contour and walked with a stiff low back, and an unsteady heel-toe walk.  Thoracolumbar ROM measurements showed flexion of 50 degrees and combined ROM of 200 degrees after repetition, with pain.  At a 21 November 2008 pain clinic examination, 4 months prior to separation, the CI reported low back pain with occasional radiation down the right leg to the calf and down the left leg to the thigh, without numbness, weakness or other neurological symptoms.  The physical examination showed no spinal deformity or muscle spasm and a normal gait.  However, there was guarding of the lumbar spine with decreased ROM in all planes and muscle tightness with trigger points.  Strength, sensation and reflexes were normal.  Maneuvers to elicit radicular symptoms provoked her typical low back pain (Slump test).  There was no sacroiliac joint tenderness.  No inconsistent pain behaviors were observed.  Surgery was not recommended because the CI had back pain without radicular symptoms.  

Prior to separation the CI received epidural steroid injections (ESIs) to the T10 and S1 areas.  A primary care examination on 18 May 2009, 2 months after separation, noted the CI appeared generally well and was without any “obvious musculoskeletal problems.”  Physical examination showed normal movement of all extremities and normal gait and stance.  At a physical therapy visit on 26 February 2010, 11 months after separation, the CI reported mid and lower back pain with intermittent right lower extremity pain.  Physical examination noted a normal gait and stance with tenderness.  Back ROM was flexion of 80 degrees with complaint of pain and combined ROM of 180 degrees.  Lower extremity strength, sensation and reflexes were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 20%, coded 5237 (lumbar spine strain), citing forward flexion of 50 degrees with spasm and tenderness.  The VA rated the back condition 40%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing flexion limited to 20 degrees as the result of pain.  

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.  The panel noted that the limitation of thoracolumbar motion recorded in the VA C&P examination met the threshold for a 40% rating.  In assigning probative value to these conflicting examinations, the panel noted the findings at other service examinations proximate to separation, although they did not report ROM in degrees, were consistent with the 20% level of disability.  The CI also was improved at examinations shortly after separation, having received additional treatment with ESIs prior to separation.  Therefore, the panel agreed that the disability due to the back condition most nearly approximated the 20% rating criteria and not the 40% rating IAW VASRD 4.7 (higher of two evaluations).  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.

BOARD FINDINGS:  In the matter of the 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.  

XXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXX

	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.

	A copy of this decision has been provided to the counsel you listed on your application, Arizona Department of Veterans Services, 1661 North Swan Road, Suite 128, Tucson, AZ 85712.

Sincerely,					      

Enclosure