RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00655
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060306

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Indirect Fire Infantryman, medically separated for “chronic non-radiating low back pain (LBP)...” with a disability rating of 10%.

CI CONTENTION: Review of all conditions is requested. 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 - 20060123	VARD - 20070207	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Non-radiating LBP	5299-5237	10%	Degenerative Disc Disease Low Back	5243	10%	20060912	
Hypertension	Not Unfitting	Hypertension	7101	10%	20060912	
Alpha-thalassemia Mild/Minor Anemia	Not Unfitting	Alpha-thalassemia/Anemia	7700	0%	20060912	
Chronic Intermittent Left Knee Pain	Not Unfitting	Left Knee Strain	5024	10%	20060912	
Hemorrhoids	Not Unfitting	Hemorrhoids	7336	0%	20060912	
Pes Planus	Not Unfitting	Bilateral Pes Planus	5276	0%	20060912	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Non-Radiating LBP.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back condition began in October 1995 after participating in multiple training exercises.  The CI underwent a lengthy period of conservative treatment, spanning over 10 years, including profiling, pain medication, rest and physical therapy.  He was not a surgical candidate.  A lumbar spine MRI was done in December 2005 and it showed minimal bulge of L5-S1 disk, and early degenerative facet joint changes at this level.  

At the November 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported he was in good health until the onset of back pain in 1995.    Physical examination showed decreased range of motion (ROM) with flexion and extension, and tenderness over the paravertebral lumbar muscles.  The 4 January 2006 MEB NARSUM examination, 2 months prior to separation, noted complaint of chronic LBP.  At the time of the NARSUM, the CI reported a baseline pain of 1-3/10 which quickly increased to 7/10 with increased activity.  He denied any radicular symptoms (no numbness, tingling or weakness into his legs).  Physical examination showed ROM forward flexion to 67 degrees (normal 90), and extension to 35 degrees (normal 30).  Painful motion was present during all ROM measurements.

At the 12 September 2006 VA Compensation and Pension (C&P) examination, 6 months after separation, the CI reported pain and soreness in the lower middle back and difficulty bending.  His condition was not associated with incapacitation.  Physical examination revealed no evidence of radiating pain, and muscle spasm was absent.  ROM recorded flexion to 90 degrees and extension to 30 degrees.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded analogously 5299-52375241 (lumbosacral strain), based on painful motion at the NARSUM examination. Likewise, the VA rated the back condition 10% coded 5243 (intervertebral disc syndrome), based on the C&P examination findings of “tenderness of the lumbar spine.”  

The panel noted the ROM recording at the NARSUM justified the 10% rating assigned by the PEB; however, there was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, justifying the 20% rating.  There was no documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes which would provide for a higher rating under that formula, or evidence of 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 concluded that there was insufficient cause to recommend a change in the PEB adjudication for the LBP condition.  

Contended PEB Conditions: Hypertension, Alpha-Thalassemia Mild/Minor Anemia, Chronic Intermittent Left Knee Pain, Hemorrhoids, and Pes Planus.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.    

BOARD FINDINGS:  In the matter of the chronic non-radiating LBP condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended hypertension, alpha-thalassemia mild/minor anemia, chronic intermittent left knee pain, hemorrhoids, and pes planus conditions, the panel recommends no change from the PEB determinations as not unfitting.  There are 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 20150601, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170006546, 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