RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00756
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070424

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E7, Cavalry Scout, medically separated for “low back pain”  with a disability rating of 10%.  

CI CONTENTION:  Review all of conditions requested.  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 - 20070322	VARD - 20070912	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5237	10%	Degenerative Disk Disease (DDD)	5242	20%	20070720	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Low Back Pain (LBP).  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back condition began in October 1999 riding in his tactical vehicle while training and he hit his back on the turret ring after the vehicle hit a rough patch on the road.  Initial lumbar spine X-rays on 9 May 2006 showed multilevel degenerative changes.  There was congenital fusion of the L3-4 left transverse processes causing a “very mild dextroscoliosis.”  An MRI done in June 2006 demonstrated mild broad-based degenerative disc bulges at L1-2 and L4-5 without evidence of central spinal canal stenosis.  The CI’s back pain was refractory to conservative treatment and he underwent surgery on 24 August 2006 for spinal fusion at L3-5.  

The 13 February 2007 MEB NARSUM examination, 2 months prior to separation, noted the CI had good resolution of his symptoms after surgery but he continued to have significant restrictions in low back motion and could not tolerate body armor or the heavy loads he was required to carry as a cavalry scout.  Physical examination showed the CI had a normal gait.  There was no tenderness or muscle spasm present.  Provocative testing for hip and sacroiliac joint pain was negative.  Strength, sensation, and reflexes were normal.  Thoracolumbar range of motion (ROM) measurements performed by physical therapy (PT) on 9 March 2007 showed flexion of 75 degrees (normal 90) and combined ROM of 180 degrees (normal 240) after repetition.  The examiner noted that “stiff mechanical block at the end range” was the reason for the limitation.  

The 12 April 2007 VA Compensation and Pension (C&P) examination, 2 weeks before separation, noted the CI continued to experience LBP when running.  Physical examination showed a normal gait.  There was mild dextroscoliosis of the lumbar spine and mild spasm with palpation of the paraspinous muscles.  The CI demonstrated mild to moderate pain and stiffness of his lumbar spine during the examination.  Thoracolumbar ROM was flexion of 70 degrees and combined ROM of 195 after repetition, all with pain noted.  There was no evidence of radiating pain to either lower extremity.  

At the 20 July 2007 C&P examination, 3 months after separation, physical examination showed normal muscle strength, sensation and reflexes, and a normal gait.  There was no tenderness, guarding or muscle spasm.  Back ROM was flexion of 60 degrees and combined ROM of 125 degrees after repetition, with painful motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded analogously 5237 (lumbar strain), citing no tenderness, or spasm and a combined ROM of 213 degrees (supporting evidence not in record) with mechanical limits.  The VA rated the low back condition 20%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination 3 months after separation, citing limitation of motion.  

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/or combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the PT and pre-separation VA examinations.  Although there was mild muscle spasm noted at the VA examination 2 weeks prior to separation, it was not 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 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.  

AR20190009991, 

Dear XXXXXXXXXXXXXXXXXXXXX:

	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.