RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01561
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060423

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Human Resources Specialist, medically separated for “chronic back pain,” with a disability rating of 0%.  

CI CONTENTION:  The CI contends for his unfitting back and a knee condition not considered by the MEB/PEB.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited 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 PEB, but determined to be not unfitting.  Any conditions outside the Board’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.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20060127	VARD - 20060523	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5237	0%	Degenerative Disc Disease of the Thoracolumbar Spine	5242	10%	20060206	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Back Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic back pain condition began September 2003 when lifting his infant son repeatedly.  Radiographic (X-ray) studies on 18 July 2005 showed congenital partial sacralization (fusion) of the L5 vertebral segment mild lumbar degenerative changes.  Magnetic resonance imaging studies on 18 August 2005 showed mild exaggerated lumbar lordosis, degenerative changes, and lower thoracic disc degeneration.  There was no narrowing of the neuroforamina (space through which the spinal nerve root passes).  An orthopedic examiner on 31 August 2005 determined that there was no surgical indication.  Despite treatment, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “back pain” for PEB adjudication.  At the MEB examination (recorded on DD Form 2807 and 2808) dated 13 October 2005, 7 months prior to separation, the CI reported constant low back pain that rated 4/10 scale.  Physical examination showed lordosis and mild kyphosis (abnormal curvature) of the spine.  There was positive radiculopathy testing on the right leg at 65 degrees.  

At the VA Compensation and Pension (C&P) examination on 6 February 2006, performed 2 months before separation, the CI reported chronic thoracolumbar back pain. He denied balance, coordination, or other neurologic except for tingling on the left anterior thigh related to his back pain.  Physical examination showed no muscle spasm or guarding and spinal contour was normal.  There was tenderness on the L2-3 going down into the right buttock.  There was limited forward flexion to 85 degrees with pain and tenderness to palpation on the right lumbosacral spine. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic back pain condition 0% coded 5237 (lumbosacral strain), citing flexion to 90/95 degrees and pes cavus, normal gait, no spasm, and no tenderness.  The VA rated the chronic back pain condition 10% coded 5242 (degenerative arthritis of the spine), based on the VA C&P examination 2 months before separation, citing degenerative disk disease with flexion limited to 85 degrees.  The Board 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 range-of-motion (greater than 120 degrees but not greater than 235 degrees) reported on the (VA and MEB NARSUM) examinations respectively.  The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI had mild lumbar lordosis and there were symptoms of intermittent radiating pain and left lower extremity numbness documented in the treatment records; however, examinations indicated normal strength, reflexes, and the sensory changes did not affect his job.  While the CI experienced radiating pain from the back condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  There was no objective evidence of a radiculopathy with functional impairments such as weakness with a direct impact on fitness that were separately functionally impairing for duty.  The Board therefore concluded that additional disability rating was not justified on this basis.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommended a disability rating of 10% for the chronic back pain condition, coded 5237.

BOARD FINDINGS:  In the matter of the chronic back pain condition, the Board unanimously recommends a disability rating of 10%, coded 5237 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior to medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Back Pain Condition	5237	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140403, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20160007299,  XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board's recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical
Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.

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.

A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Deputy Assistant Secretary of the Army

Enclosure