RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00440
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20061120

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E-4, Medical Specialist, medically separated for “chronic low back pain” with a disability rating of 0%.

CI CONTENTION:  His back problems changed his quality of life.  The 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 review of disability ratings assigned 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 or non-compensable.  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 determination 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(s) 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 - 20061023	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain (LBP)	5299-5242	0%	No VA Claim Completed	
RATING:  0%	RATING:  NA	

ANALYSIS SUMMARY:

Chronic LBP.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s LBP condition began in January 2004 at his civilian job.  In June 2004 the CI reported recurrence of LBP during a field exercise.  An MRI on 14 July 2004 showed herniated discs at L4-5 an L5-S1.  In October 2004 the CI underwent a discectomy.  

The 15 June 2005 MEB NARSUM examination, 5 months before separation, noted complaints of LBP with radicular pain down the left lower extremity.  Physical examination revealed a shuffled gait and the CI grimaced with movement.  The lumbar range of motion (ROM) of flexion to 10 degrees (normal 90) and the combined ROM was 60 degrees (normal 240); painful motion was not addressed.  Radicular testing of the left lower extremity was positive.  There was no evidence of sensory deficits or muscle spasms.

At the 15 Jun 2005 VA Compensation and Pension (C&P) examination, also 5 months before separation, the CI reported LBP and decreased ROM.  Physical examination showed a normal appearing lumbar spine without tenderness or muscle spasms.  Thoracolumbar ROM was 65 degrees of forward flexion and combined ROM was 170 degrees; painful motion was not addressed.  Radicular testing was positive; however, the neurological examination was normal.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP condition 0%, analogously coded 5299-5242 (degenerative arthritis of the spine), citing ROM limited by pain.  Though the CI attended a C&P examination, a VA disability claim was not completed.  

The panel noted the differing ROM measurements between the MEB physical therapy (PT) and VA examinations performed 15 June 2005.  The MEB PT ROM testing was performed using an inclinometer and noted flexion was reported to be 20 degrees which was inconsistent with the C&P examination results of flexion 65 degrees and a combined ROM of 170 degrees.  The panel noted the PT methodology did not conform to the VASRD rating formula which is based on a goniometric measurement of thoracolumbar flexion (IAW VASRD §4.46); therefore the panel concluded that the C&P examination was the most probative and reflected the disability at the time of separation.

Panel members agreed that the totality of the STR and C&P examinations support a 10% rating for thoracolumbar spine forward flexion between 60 to 85 degrees and a combined thoracolumbar ROM between 120 and 235 degrees.  The evidence did not support a higher rating for intervertebral disc syndrome with incapacitating episodes under that formula or a ratable peripheral nerve impairment which would provide for additional rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the LBP condition.

BOARD FINDINGS:  In the matter of the LBP condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5242 IAW VASRD §4.71a.  In the matter of the contended left lower extremity radicular pain condition, the Board unanimously agrees that it cannot recommend it for additional disability rating.  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 his prior medical separation:

CONDITION	VASRD CODE	RATING	
Chronic LBP	5299-5242	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150601, w/atchs
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

10 Apr 17

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170004775 (PD-2015-00440)

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, I accept the Board’s recommendation to modify the individual’s disability rating to 10% without recharacterization 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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA