RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00104
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060531

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Satellite Communication Systems Operator/Maintainer, medically separated for “chronic back pain,” with a disability rating of 10%.

CI CONTENTION:  “Rating is under what rating should be.  Request at least 30% to receive retiree status and receive benefits associated with starting Jun 2006.”  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 based upon a 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 - 20060518	VARD - 20061219	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5241	10%	Status Post L3-S1 Fusion	5243	40%	20060330	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic Back Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), indicated the CI underwent back surgery, (spinal fusion) in November 2004 for herniated discs.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic low back (moderate/constant) pain status post fusion L3 to S1 with nonunion and limited range of motion” for PEB adjudication.  The MEB NARSUM examination on 14 March 2006, 2 months prior to separation, noted complaints of constant pain rated as 5/10, aggravated by prolonged standing, prolonged sitting, and walking for more than a mile.  Physical examination showed pain limited thoracolumbar range of motion (ROM) of flexion 65 degrees (normal 90), extension 12 degrees (normal 30), left lateral flexion 38 degrees ( normal 30) and right lateral flexion 41 degrees (normal 30), left lateral rotation 34 degrees (normal 30), and right lateral rotation 42 degrees (normal 30).  ROM was limited by pain.  Radiographic imaging indicates there is no evidence of disk herniation, disk protrusions, or disk bulges.  There are no areas of central spinal stenosis seen.  The radiologic impression was noted as status post posterior fusion of the L3 through S1 vertebrae showing good bony alignment.  

At the 30 March 2006 VA Compensation and Pension (C&P) evaluation, performed 2 months before separation, the CI reported the pain occurred once a day and each time lasted for 1 hour rated 3/10. He used Tylenol for pain. The CI reported that he had 60 incidents of incapacitation for a total of 60 days over the past year.  The condition did not result in any lost time from work. Physical examination showed there was ankylosis of the lumbar spine and the ankylosis position was favorable. ROM was not performed because the spine was ankylosed. There were no signs of intervertebral disc syndrome with chronic and permanent nerve root involvement. Muscle spasm was absent. There was tenderness noted on examination of the mid lumbar.  

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the back condition 10%, coded 5241 (spinal fusion), citing painful motion and limitation of motion.  The VA rated the back condition 40% coded 5243 (intervertebral disc syndrome), citing incapacitating episodes 20 days a month, and forward flexion of the thoracolumbar spine of 30 degrees or less. (This measurement is not documented in the record).  Board members agreed that that the evidence supports a 10% rating for forward flexion (greater than 60 degrees but not greater than 85 degrees) reported on the MEB NARSUM examination.  A 40% rating required favorable ankylosis of the entire thoracolumbar spine.  There was evidence of surgical fusion of the lumbar spine resulting in fixed movement of the lumbar spine as noted in the service treatment records; however, treatment records evidenced upper thoracic movement.  The VA also noted favorable ankylosis of the lumbar spine and did not test thoracic movement.  

Members agreed that the MEB NARSUM examination was more consistent with service treatment records and more reflective of the anticipated severity based on the clinical pathology.  Therefore, based on all evidence and associated conclusions just elaborated, Board consensus was that preponderant probative value should be assigned to the MEB NARSUM physical therapy ROM examination. Board member agreed that that the evidence supports a 10% rating as adjudicated by the PEB.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the chronic back pain condition.  

BOARD FINDINGS:  In the matter of the chronic back pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150119, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

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

02 DEC 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXXAR20160017965 (PD201500104)

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, I accept the Board’s recommendation and hereby deny the individual’s application. This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA