RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01117
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070816

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Health Care 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 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 panel 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 - 20070620	VARD - 20071129	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5237	0%	HNP L4-5/Degenerative Disc Disease	5242	10%	20070709	
Bilateral Plantar Fasciitis	Not Unfitting	Bilateral Pes Planus	5276	10%	20070709	
Tinnitus		Tinnitus	6260	10%	20070717	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back condition began in February 2005 without any specific injury or trauma.  Radiographic (X-rays) studies revealed degenerative disc disease (DDD) with mild disk bulging of the low lumbar spine without nerve compression.  Despite conservative treatment, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  The MEB forwarded “chronic low back pain” for PEB adjudication.  The 18 May 2007 MEB NARSUM examination, 3 months prior to separation, noted complaints of daily back pain with occasional numbness and tingling into his left lower extremity.  His symptom were aggravated by running, prolonged standing, sitting, or brisk walking.  He reported that his condition had not caused him to miss any work.  His detailed physical examination revealed globally decreased and painful thoracolumbar range of motion (ROM) with a flexion of 35 degrees (normal 90) and a combined ROM of 130 degrees (normal 240).  All other examination parameters were normal to include distal sensation, reflexes, gait, and spinal contour.  

At the 9 July 2007 VA Compensation and Pension (C&P) examination, performed 1 month prior to separation, the CI reported 6/10 back pain that traveled to his left leg.  He reported no incapacitation from his back condition.  Physical examination revealed full, but painful ROM of the thoracolumbar spine.  Spinal tenderness was present without associated spasms.  There was no evidence of radiating pain into the lower extremity and no signs of intervertebral disc syndrome with chronic and permanent nerve root involvement.  His gait, spinal contour, motor strength, reflexes and sensation were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 0%, analogously coded 5299-5237 (lumbosacral strain), citing ROM limited by pain without tenderness or evidence of spasm.  The VA rated the back condition at 10%, coded 5242 (degenerative arthritis of the spine), citing painful motion.  Although there was insufficient limitation of motion to support a minimum rating, the panel agreed a 10% rating was justified for the presence of painful motion and tenderness as indicated on the more probative C&P examination being 1 month proximate to separation.  Absent muscle spasms 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.  

The panel considered if additional disability rating was justified for peripheral nerve impairment due to a radiculopathy.  The CI reported symptoms of radiating pain documented in the STR; however, examinations indicated normal strength, reflexes, sensation and gait.  The presence of functional impairment with a direct impact on fitness is the key determinant in the Panel’s decision to recommend any condition for rating as additionally unfitting.  While the CI may have suffered additional pain from associated nerve involvement, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  Therefore the critical decision is whether or not there was a significant motor weakness which would impact military occupation-specific activities.  There was no evidence in this case that motor weakness existed to any degree that could be described as functionally impairing.  The Panel therefore concluded that an additional disability rating was not justified on this basis.  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 back condition, coded 5242.  

Contended PEB Conditions:  Bilateral Plantar Fasciitis and Tinnitus.  The panel’s main charge is to assess the fairness of the PEB’s determination that these contended conditions were not unfitting.  Although both of these conditions were listed on the final profile, neither of them required significant profile restrictions and neither of the conditions were implicated in the commander’s statement or judged to fail retention standards.  The commander stated that the CI’s duty performance had been to standard and that his profile had not hindered his performance or ability to complete tasks efficiently.  The commander also indicated that he recommended that the CI be found fit for duty in a garrison duty assignment.  There was no performance-based evidence from the record that either of these 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 low back pain condition, the panel unanimously recommends a disability rating of 10%, coded 5242 IAW VASRD §4.71a.  In the matter of the contended bilateral plantar fasciitis and tinnitus conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There were 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 the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Low Back Pain	5242	10% 	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150610, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170011696, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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,	
Enclosure