RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00785
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040412

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Cannon Crewmember, medically separated for “chronic low back pain [LBP]” with a disability rating of 10%.

CI CONTENTION:  Back condition was more serious than determined by the PEB.  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 - 20040128	VARD - 20040910	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP…	5237	10%	Chronic Low Back Strain	5237	20%	20040604	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic LBP.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in May 2001 after a motorcycle accident.  Multiple radiographic studies in 2002 and 2003 showed a normal lumbar spine.  An orthopedic evaluation diagnosed mechanical LBP and recommended non-surgical treatment.

At the 18 November 2003 MEB orthopedic NARSUM evaluation, 5 months prior to separation, the CI reported LBP exacerbated by running, jumping, or lifting over 20 pounds.  Physical examination revealed a normal gait and neurological examination.  The range of motion (ROM) was flexion to 60 degrees (normal 90); painful motion was not addressed.  The combined ROM could not be calculated because lateral rotation was not measured.  Provocative testing for nerve root irritation was negative bilaterally.

During the 3 December 2003 MEB examination (recorded on DD Forms 2807-1 and 2808 and in the NARSUM),  4 months prior to separation, the CI reported back pain when bending, lifting, running, lying in the wrong position, walking more than 20 minutes, or standing more than 15 minutes.  Physical examination noted back tenderness with no spasm or deformity.  The neurological examination was normal except for decreased right calf and foot sensation.  The ROM flexion was to 65 degrees and combined ROM was 200 degrees (normal 240) with painful motion.  Provocative tests for nerve root impingement were negative bilaterally.

At the 4 June 2004 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported LBP which radiated down the right leg into the foot.  The CI denied spinal or extremity weakness.  He reported two episodes of incapacitation due to the back condition in the past 12 months, each for 2-3 days duration.  Physical examination revealed a steady gait with a normal posture, spinal curvature and neurological examination.  Spinal tenderness was present.  The ROM was flexion to 50 degrees and combined ROM was 135 degrees with painful motion.  Radiographic studies of the low back revealed no abnormalities.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP 10%, coded 5237 (lumbosacral strain), citing the presence of tenderness.  The VA rated the LBP condition 20%, also coded 5237 code, based on the C&P examination 2 months after separation, citing limitation of flexion.

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) as reported on the MEB and 1 January 2004 updated ROM examinations.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no evidence of intervertebral disc syndrome which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under that alternate VASRD formula.  Additionally, there was insufficient evidence of a clinically significant radiculopathy that interfered with performance of military duties to consider a separate peripheral nerve 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 lower back pain condition.

BOARD FINDINGS:  In the matter of the lower back pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150603, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170007437, 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,