RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00634
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090220

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Infantryman, medically separated for “chronic low back pain” with a disability rating of 10%.  

CI CONTENTION:  “Review 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 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 conditions at the time of separation.  The panel has neither the role nor the authority to compensate for progression or complications of service connected conditions after separation.  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 -20090114	VARD - 20091024	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Low Back Condition	5237	0%	STR	
Dermatophytosis Tinea Pedis	Not Unfitting	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP).  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in July 2008 after a fall during a ruck march.  Radiographic imaging in August 2008 showed bulging of the L2-S1 intervertebral discs, worse at L4-L5 with no surgical indication.  At the 19 November 2008 MEB examination (recorded on DD Forms 2807 and 2808), 3 months prior to separation, the CI reported pain, numbness and tingling.  The physical examination (PE) was “normal.”  At the 25 November 2008 MEB NARSUM examination, the CI reported increased pain with walking, wear of equipment, and pain radiating to both legs, right greater than left.  The PE showed a normal gait, no ambulatory aids, and the ability to rise from a chair without use of the arms.  There was tenderness of the paravertebral muscles and along the spinous processes.  The neurologic examination was normal.  At a physical therapy (PT) visit the same day, the ROM was recorded as flexion of 70 degrees (normal 90), with evidence of painful motion.  There was no VA Compensation and Pension evaluation in evidence proximate to separation. 

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated 10% for the LBP condition coded 5237 (lumbosacral strain), citing normal imaging, flexion to 70 degrees and no evidence of spasm or radiculopathy.  The VA rated the back condition 0%, coded 5237, based on the STR.  The panel 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 ROM (greater than 120 degrees but not greater than 235 degrees) reported on the PT examination proximate to separation.  There was no evidence of muscle spasm or guarding severe enough to result in abnormal gait or spinal contour.  There were no periods of physician-prescribed bed rest noted in the record to support a higher rating under the alternate formula for intervertebral disc syndrome (5243).  Although occasional radiating pain and subjective numbness were reported prior to separation, there were no objective neurologic abnormalities and there was insufficient evidence to indicate impairment of duty due to any radiculopathy.  Pain, whether or not it radiates, is rated under the general spine rating formula.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the LBP condition.  

Contended PEB Condition:  Dermatophytosis Tinea Pedis.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement nor judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

PANEL FINDINGS:  In the matter of the chronic LBP condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended dermatophytosis tinea pedis condition, the panel unanimously recommends no change from the PEB determination as not unfitting.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150603, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170004779, XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.

Sincerely,					       
						      					
Enclosure