RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00717
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20021018
______________________________________________________________________________

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E7, Personnel Services Specialist, medically separated for “chronic low back pain” with a disability rating of 0%.  

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 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 - 20020614	VARD - 20040324	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5295	0%	Lumbar Degenerative Disc Disease	5299-5292	10%	20040120	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain. According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM) the CI had an atraumatic onset of low back pain in July 2001.  There were earlier STR entries that noted bilateral lower extremity radiation, but later entries indicated that no radicular complaints were present.  Mild degenerative changes were demonstrated on radiographic (X-ray) studies.  There were multiple normal neurologic examinations in evidence and none to the contrary.  There was an earlier STR entry that documented a limitation of flexion and extension to 75% of normal, but later observations reported an improving range of motion (ROM), and no entries indicated more significant ROM limitation.  There was ample documentation of painful motion in STR clinical entries.  There was STR documentation of a normal gait with no indication of abnormal spinal contour, and there was no documentation of acute attacks (incapacitating flare-ups).  

The 28 February 2002 NARSUM examination, 8 months before separation, duplicated the history and findings of a 14 December 2001 physical medicine addendum (2 months earlier).  Both of these sources documented “constant” pain rated 4-6/10 with left lower extremity radiation and paresthesias (weakness denied), that was exacerbated by running, jumping, lifting, and load-bearing.  The physical examination recorded a normal spinal contour, paraspinal tenderness, and normal neurological findings (5/5 strength, intact sensation, symmetric reflexes).  Neither examiner commented on ROM measurements or painful motion.  

A 30 September 2002 VA Compensation and Pension examination, 2 weeks before separation, documented pain “most of the time” rated 4/10 with exacerbations to 6/10 by position change and running.  The VA examiner denied radiating pain and opined that the CI’s left leg pain was a separate and preceding condition from the lumbar disc disease.  The physical examination recorded a normal gait and spinal contour, tenderness, and normal neurological findings (motor, sensory, and reflexes).  Measured ROM was flexion to 80 degrees (normal 90) with a combined ROM of 225 degrees (normal 240), specifying painful motion in all planes but there was no degradation with repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The 2002 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 tenderness with a normal neurological examination.  Members noted, however, that the “characteristic pain on motion” criterion for a 10% rating under code 5295 was amply documented in STR clinical entries and in the pre-separation VA examination; and, thus agreed that a 10% rating under 5295 was sufficiently supported.  None of the criteria for a higher rating under that code were in evidence.  

The VA’s rating analogous to code 5292 (limitation of motion) cited the 10% criterion of “slight” limitation; with that code offering 20% for “moderate” and 40% for “severe” limitation.  Members agreed that a 10% rating under code 5292 was also quite defensible, although no rating higher than 10% under 5292 was justified by the ROM evidence.  The only remaining code available in the 2002 VASRD subject to consideration was 5293 (intervertebral disc syndrome), which was neither clinically applicable nor favorable given the absence of evidence for “recurring attacks” requisite for a higher rating.  There was 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 spine condition under code 5299-5295.

BOARD FINDINGS:  In the matter of the chronic low back pain condition, the panel unanimously recommends a disability rating of 10%, coded 5295 IAW VASRD §4.71a in effect.  There are 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 Low Back Pain	5299-5295	10%	

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

AR20170006582, XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,