DEPARTMENT OF THE AIR FORCE
WASHINGTON DC

Office of the Assistant Secretary

SAF/MRBD (PDBR)
3351 Celmers Lane
JBA NAF Washington, MD 20762-6435

MEMORANDUM FOR THE DIRECTOR, ARMY REVIEW BOARDS AGENCY

SUBJECT: Physical Disability Board of Review Recommendation on Case Number PD-2018-00140

In accordance with Title 10 § 1554a and in compliance with DoDI 6040.44, the Physical Disability Board of Review (PDBR) adjudicated the disability rating accompanying the medical separation of the covered individual (CI) from the United States Army. After carefully reviewing the application and medical separation case file, the PDBR recommended no re- characterization of the separation or modification of the disability rating previously assigned. I recommend you accept this proposed decision.

The CI was an E3, Infantryman, medically separated for “lumbosacral strain” and “cervical strain” rated 10% each, with a combined disability rating of 20%. The PEB rated the low back condition 10%, coded 5237 (lumbosacral strain), citing evidence of painful motion. The VA rated the low back condition 20%, coded 5237, based on the Compensation and Pension (C&P) examination, citing forward flexion limited to 40 degrees. The majority of examinations, including the MEB narrative summary (NARSUM), noted full or near full range of motion (ROM), without muscle spasm following an exacerbation of the CI’s back pain in November 2007. While measurements were not goniometric, the descriptions of the motion were sufficiently specific and detailed to conclude that limitation of motion did not meet the threshold for a 20% rating. While the MEB physical therapy (PT) and VA ROM measurements, performed one week after the NARSUM examination, supported a 20% rating, there was also variability in ROM between and within these results, which were one day apart. The PT study showed that flexion met criteria for a 10% rating, but combined ROM supported a 20% rating, whereas the VA examination revealed combined ROM warranting a 10% and flexion indicating a 20%. Panel members concluded from this that the CI was able to reach levels of ROM consistent with a 10% rating for both flexion and combined ROM at these examinations taken together. Additionally, the MEB PT ROM test noted the CI stopped motion at the point of pain, which might explain the discrepancies. No intervening event was documented to explain the worsening of ROM between the MEB NARSUM and the two following examinations. There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus a 20% rating was not justified on this basis. There was no evidence of intervertebral disc syndrome (IVDS) which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration under that alternate formula. Based on the total evidence in record (ROM, imaging evidence, absence of muscle spasm, and normal gait), the panel concluded that
the CI’s low back condition more nearly met criteria for a 10% rating.

The PEB rated the cervical spine condition 10%, coded 5237 (cervical strain), citing evidence of painful motion and history of spasms. The VA rated the cervical spine condition 20%, coded 5237, based on the C&P examination, citing forward flexion limited to 30 degrees. Although the CI reported some neck pain in July 2007 after a motor vehicle accident, there were no visits documented in the STR for evaluation or treatment of the neck until after initiation of the MEB for the back. As with the low back condition, cervical spine ROM measurements varied between supporting a 10% or a 20% rating proximate to separation, but the CI was able to reach levels consistent with a 10% rating for both flexion and combined ROM. There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus a 20% rating was not justified on this basis. As elaborated in the rating discussion for the low back, based on the total evidence in record, the panel concluded that the CI’s disability due to the neck condition more nearly approximated the 10% rather than 20% rating criteria IAW VASRD
§4.7. There was no evidence of IVDS which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration under that alternate formula.

In assessing the fairness of the PEB determination that the contended right knee pain was not unfitting, it was noted that the condition was not profiled or implicated in the commander’s statement, and did not fail retention standards. There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation. 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 or cervical spine conditions; or for the contended right knee pain, and so no additional disability rating is recommended.

2	PD-2018-00140

AR20200004705,

Dear

DEPARTMENT OF THE ARMY
ARMY REVIEW BOARDS AGENCY 251 18TH STREET SOUTH, SUITE 385
ARLINGTON, VA 22202-3531

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.

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