RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01296
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20091005

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E5, Petroleum Supply Specialist, medically separated for “chronic low back pain” with a disability rating of 10%.  

CI CONTENTION:  His back condition continues to be painful.  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 - 20090821	VARD - 20081223	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain…	5299-5242	10%	Lumbar Disc Disease with Disc Bulge at L4-5 and L5-S1 and Arthropathy, Right Sacroiliac Joint	5236	NSC	20080902	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s LBP condition began in December 2006 after jumping over a fence.  Radiographic studies on 2 September 2008 were normal showing no spondylolysis or spondylolisthesis.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “lumbago” for PEB adjudication.  

At the 2 September 2008 VA Compensation and Pension (C&P) evaluation, performed 13 months before separation, the CI reported intensified back pain with prolong sitting as well as prolonged ambulatory activities.  The pain would occasionally radiate down the posterior thigh region to the level of the knee, but he denied any persistent neurologic deficit.  He also denied additional weakness or restrictive range of motion (ROM) of the lumbar spine.  He used a cane intermittently during flare-ups.  He had not been incapacitated in the past 12 months for the back.  The examiner found the CI had a normal gait and there was no spasm.  There was localized tenderness to palpation.  Straight leg raise test (for radicular symptoms) was negative.  On examination ROM was active flexion to 90 degrees (normal 90), and combined was greater than 120 degrees but not greater than 235 degrees (normal 240).  There was no additional weakness, fatigability, dyscoordination, additional restricted ROM or functional impairment following repetitive stress testing.  

At the time of the MEB clinic appointment on 3 December 2008, performed 10 months before separation, the CI reported that nothing seemed to make his back better.  He also stated the pain feels like a muscle spasm and that pain radiated up the back and down to the knee.  He reported weakness in legs but no numbness in legs other than twice during that year.  On examination pain was elicited by flexion and extension.  Thoracolumbar spine had a normal appearance and showed no instability.  There were no radicular signs on examination and the CI was able to heel-walk and toe-walk.  

The MEB NARSUM examination on 4 August 2009 (2 months prior to separation) noted complaints of LBP on a daily basis.  The pain was described as 4/10.  The CI reported flares lasting 2 to 3 days with a typical frequency of 2 to 3 per month.  On examination, there was no muscle spasm or guarding and gait and spinal contour were normal.  No tenderness to palpation was noted.  No radicular signs were noted.  The CI was able to heel-walk and toe-walk without difficulty.  Straight leg raise test was negative.  No neurologic deficits were noted.  Sensation was intact to the extremities bilaterally.  The CI demonstrated good muscle strength and coordination.  On examination ROM was flexion to 90 degrees (normal 90), and combined ROM of 230 degrees (normal 240) after repetitive motion.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP condition 10%, coded 5299-5242 (degenerative arthritis of the spine), citing limitation of motion and consideration of functional loss in accordance with VASRD §4.10, §4.40, §4.45 and §4.59.  The VA did not service-connect the LBP condition and coded it 5236 (sacroiliac injury and weakness), based on the VA C&P examination 13 months before separation, citing that the evidence showed that lumbar disc disease with disc bulge at L4-5 and L5-S1 and right sacroiliac joint arthropathy existed prior to service and that there was no evidence that the condition permanently worsened as a result of service.  

The Board agreed that a 10% rating, but no higher, was justified for combined ROM (greater than 120 degrees but not greater than 235 degrees) reported on the MEB NARSUM examination.  There was no consistent muscle spasm 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 documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes which would provide for a higher rating under that formula (for IVDS), 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 Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the LBP condition.  

BOARD FINDINGS:  In the matter of the LBP condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  The Board, 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 20150610, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170005984, XXXXXXXXXXXXXXXXXX

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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,