RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2017-05700
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080403

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

CI CONTENTION:  “After getting out of the Army, I received care from a specialist in pain management.”  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 - 20080402	VARD - 20090116	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbosacral Strain	5237	10%	Lumbar Spine Strain	5237	10%	20080909	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Lumbosacral Strain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s lumbosacral condition began in June 2006 without trauma.  A spine MRI showed L5-S1 spinal canal stenosis, and she was treated with pain medication, physical therapy (PT), and sacroiliac joint steroid injections, and given an L3 profile; surgery was not indicated.  During the 24 September 2007 MEB NARSUM, 6 months prior to separation, the CI reported low back pain, and denied urinary and bowel incontinence.  Physical examination revealed spinal tenderness, but normal alignment.  The 9 October 2007 PT range of motion (ROM) study for the MEB, demonstrated goniometrically measured thoracolumbar flexion to 90 degrees (normal) and combined ROM of 195 degrees (normal 240), with painful motion.  During the 11 October 2007 orthopedic examination, 6 months before separation, the CI reported low back pain for approximately one year.  Physical examination revealed a normal gait and heel and toe walking.  Tenderness was present and “spine” ROM was recorded as “full,” with no painful motion.  

At the 9 September 2008 VA C&P examination, 5 months after separation, the CI reported constant pain all across the low back with intermittent aching pain radiating down to both buttocks and the right lower extremity.  Physical examination revealed a normal gait and spinal curvature with no tenderness or muscle spasm.  Lumbar flexion was 70 degrees and combined ROM was 190 degrees, with painful motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the lumbosacral condition 10%, coded 5237 (lumbosacral strain), citing ROM limited by pain.  The VA also rated the lumbosacral condition 10%, coded 5237, based on the C&P examination, citing limitation of flexion or combined ROM.  Panel members 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 MEB PT and VA ROM 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 also was no evidence of intervertebral disc syndrome 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 lumbosacral condition.  

BOARD FINDINGS:  In the matter of the lumbosacral stain 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-2017-05700

XXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXX

	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.

PD-2017-05700