RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03802
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030630

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, PADS vehicle driver, medically separated for “chronic low back pain due to lumbar degenerative disc disease without neurologic abnormality,” with a disability rating of 10%.  

CI CONTENTION:  The applicant makes no specific contention in their application.  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 Physical Evaluation Board (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 - 20030418	VARD - 20040325	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain Due to Degenerative Disc Disease	5299-5295	10%	Degenerative Disc Disease L5-S1	5237-5242	20%	20031031	
RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Low Back Pain due to Degenerative Disc Disease (DDD).  In March 1999, the CI developed back pain after lifting heavy equipment.  X-rays revealed DDD of the lumbosacral spine.  Despite physical therapy, medication and restrictions, his low back symptoms remained.  In November 2002, he was permanently profiled and referred to a Medical Evaluation Board (MEB).  At the MEB narrative summary (NARSUM) examination performed 3 months prior to separation, the CI’s chief complaint was “back pain” without additional comments.  He endorsed the inability to bend, run, or climb.  On examination, his thoracolumbar range of motion (ROM) was described as “he forward flexes approximately a quarter of the way forward.”  There was no comment in regards to other ROM measurements.  Painful motion was present and motor and sensory parameters were normal. 

At the VA Compensation and Pension (C&P) examination performed 4 months after separation, the CI reported no new or additional physical complaints.  His physical examination revealed a normal posture and gait.  There was lumbosacral spasm and tenderness present.  Thoracolumbar ROM was not assessed due to the CI’s refusal to be examined secondary to him “…hurting so bad.”  He was neurologically intact.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under code 5295 (lumbosacral strain), utilizing the 2003 VASRD rating rules, citing characteristic pain on motion.  The VA assigned a 20% rating under the analogous 5237-5242 code (lumbosacral strain-degenerative arthritis) under current VASRD guidelines, citing limited motion.  Board members first considered examination probative value (PV) in this case and concluded that both the pre-separation NARSUM and the post-separation VA exam be apportioned near equal PV in determining a final impairment rating.  The VASRD coding possibly applicable in this case include codes 5292 (limitation of lumbar motion), 5293 (intervertebral disc syndrome), or 5295.  Absent VASRD defined incapacitating episodes, 5293 was not applicable.  Board members deliberated and concluded that 75% loss of forward flexion of the lumbar spine as well as the presence of paraspinal spasm and tenderness more accurately reflected a “moderate” 20% level of impairment.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommended a disability rating of 20% for the low back condition, coded 5292.  

BOARD FINDINGS:  In the matter of the lumbar spine condition, the Board unanimously recommends a disability rating of 20%, coded 5292 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 medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Low Back Pain	5292	20%	
RATING	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140818, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for AR20160009354 (PD201403802)

1.    I have reviewed the enclosed Department of Defense Physical Disability Board of
Review (DoD PDBR) recommendation and record of proceedings pertaining to the
subject individual. Under the authority of Title 10, United States Code, section 1554a,
accept the Board's recommendation to modify the individual's disability rating to 20%
without re-characterization of the individual's separation. This decision is final.

2.    I direct that all the Department of the Army records of the individual concerned be
corrected accordingly no later than 120 days from the date of this memorandum.

3.    I request that a copy of the corrections and any related correspondence be provided
to the individual concerned, counsel (if any), any Members of Congress who have
shown interest, and to the Army Review Boards Agency with a copy of this
memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

CF:
( ) DoD PDBR
( ) DVA