RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-05185
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060630

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E5, Tracked Vehicle Mechanic, medically separated for “low back pain and right sacroiliac (SI) pain” with a disability rating of 10%.  

CI CONTENTION:  Review of her back was requested along with 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 – 20060414	VARD - 20080206	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain and Right SI Pain	5299-5242	10%	Ruptured Disk L5-S1	5242	10%	20070116	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Low Back Pain and Right SI Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began on 24 August 2003 after strenuously swinging a sledgehammer to remove a pin from a piece of heavy equipment.  The 15 December 2005 X-ray report revealed degenerative arthritis of the lumbar spine.  During the 12 June 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 13 months prior to separation, the CI reported chronic low back pain.  Physical examination showed a normal gait and no tenderness.  Range of motion (ROM) of the lumbosacral spine was reported as decreased and painful, but actual measurements were not provided.  

At the 8 December 2005 physical therapy (PT) examination, 7 months prior to separation, the CI reported lumbar pain.  Physical examination showed thoracolumbar ROM measurements, flexion of 75 degrees (normal 90) and combined ROM of 180 degrees (normal 240) after repetition, limited by pain.  Muscle spasms and abnormal gait were not specified.  The next-day MEB NARSUM examination noted complaints of pain in the lower back with weight bearing activities, prolonged sitting or standing.  An MRI (referenced, but not in evidence) on 6 December 2005 revealed degenerative intervertebral disc disease at multiple levels with L5-S1 disc protrusion posteriorly without nerve root compression.  EMG and nerve conduction study of the right lower extremity was normal.  Physical examination showed diffuse lumbosacral tenderness but focal point tenderness at the right posterior superior iliac spine.  Further testing for Faber and Gaenslan signs were consistent with SI inflammation on the right side.  Strength, sensation and reflexes of the lower extremities were intact.  ROM was noted as lumbar/lumbosacral spine motion with flexion of 60 degrees, extension of 10 degrees (normal 30), left lateral flexion of 20 degrees (normal 30) and right lateral flexion of 10 degrees (normal 30), with no rotation measurements provided.  Pain was reported as 7/10 with motion; muscle spasms and abnormal gait were not cited.  

At the 16 January 2007 VA Compensation and Pension (C&P) examination, 7 months after separation, the CI reported right lower back pain with radicular symptoms into the right buttock and posterior thigh to the dorsum of the right foot and associated with “spasms” in both feet when walking.  The CI denied any flare-ups or incapacitating episodes.  Physical examination showed the CI ambulated with a cane and walked with a limp; the CI reported some numbness in the lateral aspect of the right calf and foot.  Muscle strength and sensory examinations were intact.  Straight leg raise tests were negative.  ROM showed forward flexion of 90 degrees and combined ROM of 220 degrees with pain at end ROM.  There was paraspinous muscle tenderness bilaterally with right greater than left paraspinous muscle spasm.  The limp was not attributed to muscle spasms severe enough to result in an abnormal gait.  There were no additional limitations following repetitive use.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5299-5242 (degenerative arthritis of the spine), citing ROM limited by pain.  The VA also rated the back condition 10%, coded 5242 based on the C&P examination, citing combined ROM of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees.  

In accordance with VASRD §4.66 (SI joint), “the lumbosacral and sacroiliac joints should be considered as one anatomical segment for rating purposes,” therefore the panel considered the low back pain and sacroiliac dysfunction together for rating purposes.  All the ROM examinations were performed about the same time relative to separation.  In assigning probative value to these somewhat conflicting examinations, the panel discussed the significantly worse flexion value (60 degrees), noted the NARSUM examination compared to 75 degrees flexion recorded the day before at the MEB PT examination and 90 degrees at the post-separation VA examination.  The NARSUM ROM measurements were noted as lumbar/lumbosacral spine measurements and not the current VASRD guidelines of the thoracic and lumbar ROM.  Therefore this examinations probative value was judged to be compromised.  The ROM examination was also incomplete (did not include rotation measurements) and gait was not addressed.  

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 combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the MEB PT and VA examinations.  Although there was muscle spasm right greater than left reported on the VA examination, the examiner did not indicate the spasms were severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  The panel did review other examinations, but did not find evidence of muscle spasms severe enough to alter gait or spinal contour.  There was no evidence of intervertebral disc syndrome which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula for that condition.  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 low back condition.  

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.   

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.