RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00181
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20011121

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Light Wheeled Vehicle Mechanic, medically separated for “low back pain…” with a disability rating of 0%.

CI CONTENTION:  The CI requested consideration of all conditions.  The CI’s 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 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 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.  Furthermore, the panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determinations is based on 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 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, operating 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 the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20010827	VARD - 20011207	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain…	5299-5295	0%	Lumbar Strain	5295	10%	20011022	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM) the CI initially injured his back in a motorcycle accident in 1998 (3 years before separation).  He suffered persistent back pain without radicular symptoms.   Multiple neurologic examinations were normal (none to the contrary), and imaging (X-ray and MRI) was normal with no indication of disc disease or nerve involvement.  There was STR evidence of non-specifically decreased and painful or “guarded” range of motion (ROM), but no STR entries that indicated severe ROM limitation.  There was STR documentation of a normal gait with no contrary entries, and there was no STR documentation of acute attacks (incapacitating flare-ups).  Surgery was not indicated.  The MEB forwarded “low back pain” for PEB adjudication.  

The 27 March 2001 NARSUM examination, 8 months before separation, documented right-sided low back pain rated “slight ... and constant” that limited prolonged sitting or standing, running and exercise.  The physical examination recorded the absence of spasm, grossly normal ROM, and normal neurological findings.

A 22 October 2001 VA Compensation and Pension (C&P) examination, 1 month before separation, documented “pain at rest in the lower back” (no mention of radiation) rated 2+/5 without specifying functional limitations.   The physical examination recorded a normal gait, “painful motion and tenderness,” and normal neurological findings (5/5 strength, intact sensation, symmetric reflexes).  Measured ROM was flexion to 90 degrees (normal) with a combined ROM of 240 degrees (normal), annotating “motion with increased pain.”

The panel directed attention to its rating recommendation based on the above evidence.  The 2001 VASRD coding and rating standards for the spine, which must be applied to the panel’s recommendation IAW DoDI 6040.44, differed significantly from the current §4.71a general rating formula for the spine.  The PEB’s 0% rating under the older code 5299-5295 (analogous to lumbosacral strain) cited an “essentially unremarkable” physical examination and the absence of neurological deficit.  Members noted, however, that the “characteristic pain on motion” criterion for a 10% rating under code 5285 was amply documented in STR clinical entries, in the NARSUM, and in the pre-separation VA examination.  The VA’s 10% rating under code 5295 cited that criterion.  Members thus agreed that a 10% rating under 5295 was well supported, although none of the criteria for a higher rating under the code were in evidence.  The normal ROM in evidence at separation precluded a higher rating under the older code 5292 (limitation of motion), and the only remaining code available in the 2001 VASRD was 5293 (intervertebral disc syndrome).  The latter was neither clinically applicable nor favorable given the absence of evidence for “recurring attacks” requisite for a higher rating.  There was also no evidence for ratable peripheral nerve impairment to support additional rating.

After due deliberation, considering all of the evidence and conceding VASRD §4.3 (reasonable doubt), the panel recommends a 10% rating for the lumbar condition under code 5295.

PANEL FINDINGS:  In the matter of the lumbar condition, the panel unanimously recommends a disability rating of 10%, coded 5295 IAW VASRD §4.71a.  There were no other conditions within the panel’s scope of review for consideration.

The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Lumbosacral Strain	5295	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20141107, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Reco

SAMR-RB										

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

10 Apr 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170004981 (PD-2015-00181)

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 10% 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