RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2017-05269
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080727

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E5, Health Care Specialist, medically separated for “low back pain” with a disability rating of 10%.

CI CONTENTION:  No specific contention was made.  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 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 - 20080528	VARD - 20090202	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5237	10%	Degenerative Changes of the Lumbosacral Spine, L5-S1	5242	10%	20080822	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Low Back Pain (LBP).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s LBP began in fall of 2006 and resolved but returned with increased training activities.  In July 2007 after lifting during training his pain increased.  An MRI in 6 August 2007 showed degenerative disc disease and a small disk herniation at L5-S1.  There was no surgical indication.  

The 28 December 2007 MEB NARSUM examination, 7 months prior to separation, noted complaints of LBP.  Physical examination showed no abnormal spinal contour, spinal guarding, tenderness, or muscle spasm.  Range of motion (ROM) testing that day was “normal.”  An undated range of motion (ROM) testing sheet showed a normal gait and no tenderness, muscle spasms or guarding.  Repetitive-goniometric thoracolumbar flexion was 90 degrees (normal) and combined ROM was 205 degrees (normal 240) limited by pain.

At the 22 August 2008 VA Compensation and Pension (C&P) examination, one month after separation, the CI reported LBP.  Physical examination showed a normal gait and posture.  There was no spine, paraspinal muscles or sacroiliac joints tenderness, and no muscle spasm.  Lumbar spine flexion was 90 degrees and combined ROM was 240 degrees.  Painful motion was absent and there was no loss of ROM following repetitive motion.  Lumbar spine X-rays were negative.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP condition 10%, coded 5237 (lumbosacral strain), citing painful motion.  The VA rated the LBP condition 10%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing painful motion.  The panel agreed that a 10% rating, but no higher, was justified for limitation of combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the undated ROM sheet at the time of the MEB NARSUM examination.  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 documentation of intervertebral disc syndrome 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 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.

	PD-2017-05269

ARXXXXXXXXXXX, XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXX

	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.

Sincerely,					      

Enclosure

	PD-2017-05269