RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXX	CASE: PD-2017-05205
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20080725

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E6, Light Wheeled Vehicle Mechanic, medically separated for “chronic low back pain (LBP)” with a disability rating of 20%.

CI CONTENTION: “Complained of cervical spine as well as lumbar spine problems which were not addressed by PEB.” Review was also requested of an additional condition 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 – 20080505	VARD - 20080430	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP	5237	20%	Degenerative Arthritis and Chronic Lumbar Strain	5237	10%	20080313	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 50%	

ANALYSIS SUMMARY:

LBP. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition began while deployed in approximately September 2004 when he developed acute onset of back pain while on a convoy. The CI denied any specific trauma and remained in theater for the duration of the deployment. After release from active duty the CI again experienced back pain with right lower extremity radicular symptoms while doing yardwork. He was evaluated by the VA and physical therapy was initiated, however the back pain persisted. MRIs were reportedly completed in April 2006 and November 2007 with an impression

of mild degenerative disc disease at L4-L5 and L5-S1 with a small central disc extrusion at L4-L5 and small broad based protrusion at L5-S1. The CI underwent epidural steroid injections. He was evaluated by neurosurgery and surgery was not indicated at that time. The 29 November 2007 MEB physical examination (recorded on DD Forms 2807-1 and 2808), 8 months prior to separation, noted limited range of motion (ROM) with pain radiating to the lower extremity with flexion and extension.  No measurements were provided.

At the 13 March 2008 VA Compensation and Pension (C&P) examination, 4 months before separation the CI reported constant pain in the low back. The pain would intensify after being on his feet for several hours and radiated to the mid back as well as the groin and left hip several times a day. The pain did not interfere with his ability to work at his civilian job (extruder operator at a paper mill) since his release from active duty in 2004. Physical examination showed a normal posture and gait. Thoracolumbar ROM showed forward flexion of 80 degrees (normal 90) with pain. Combined ROM was 220 degrees (normal 240) with painful motion. There was no further restriction in motion on repetitive use. There was no evidence of muscle spasm or guarding. X- ray of the otherwise normal lumbar spine showed minimal hypertrophic degenerative disease at L3-4 and L5-S1.

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 loss of spinal motion in accordance with the VASRD General Rating Formula for Diseases and Injuries of the Spine. The VA rated the back condition 10%, coded 5237, based on the C&P examination, citing flexion of 70 degrees and combined ROM of 195 degrees.

The panel noted the PEB assessed a rating based on where painful motion began (60 degrees) and not on full excursion of flexion (80 degrees) or combined ROM. 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 both the NARSUM and VA examinations. There was no muscle spasm or guarding severe enough to result 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 rating under that alternate VASRD formula. The panel concluded there was no evidence to support a rating higher than that adjudicated by the PEB and the panel cannot recommend a lower rating. 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 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.

AR20190008479, 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.