RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01312
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030815

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

CI CONTENTION:  The CI made no specific contention.  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 – 20030502 	VARD - 20050805	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain 	5293-5299-5295	10%	Degenerative Disk Disease, L4- L5	5243	0%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in August 1999 without any specific injury or trauma.  Treatment consisted of Naprosyn (naproxen, a nonsteroidal anti-inflammatory drug (NSAID)).  A physical therapy evaluation in September 1999 assessed the condition as lumbar dysfunction at L5-S1 without evidence of radiculopathy.  Back exercises were instituted.  Osteopathic manipulation therapy (OMT) was carried out on 23 October 2000 for sacroiliac (SI) subluxation.  Magnetic resonance imaging (MRI) demonstrated a mild focal disk bulge at L4-L5 with no evidence of a herniated nucleus pulposus.  At a clinic visit on 23 October 2000 there was a full ROM of the lumbar spine with tenderness to palpation over the spine from L1-L5 as well as over the SI joints bilaterally.  The L2-L4 vertebrae were rotated left; the left PSIS (posterior superior iliac spine) had posterior subluxation; and there was sacral unleveling.  OMT was performed with corrections tolerated well.  Because of low back pain for 1½ years with radiation to the lateral aspects, but not to the lower extremities, the CI underwent an epidural steroid injection in April 2001.  In November 2002 the CI had an episode of back pain.  X-rays of the lumbosacral spine in February 2003 were normal.     

The 18 February 2003 MEB NARSUM examination, 6 months prior to separation, noted complaints of pain that did not radiate throughout her extremities, but radiated regionally along the lumbosacral junction and were associated with spasms of the paraspinal musculature.  The severity was worse depending on level of activity, and exacerbating factors included running, jumping, lifting greater than 15 pounds.  Physical examination showed spinal contours were roughly within normal limits.  The CI had tenderness to palpation in her lower back at the lateral posterior superior iliac spines, left greater than right, reproducing her symptoms of low back pain.  Range of motion (ROM) measurements using a bubble goniometer showed 60 degrees forward flexion, 20 degrees extension and 35 degrees of right and 40 degrees of left lateral flexion.  Straight leg testing (to determine nerve root irritation) was negative.  FABER (flexion, abduction and external rotation) testing (to determine hip pathology) was positive. Neurologic evaluation was unremarkable and muscle strength was 5/5.  The examiner’s diagnosis was bilateral sacroiliac joint pain syndrome. 

During the 5 March 2003 the MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported lower back pain for 4 years and a possible bulging disk.  Physical examination showed the ROM of the lumbosacral spine was normal.  There was no VA examination in evidence proximate to separation.

A visit for back pain occurred in March 2004, 7 months after separation.  Examination on 15 April 2004, 8 months after separation, revealed the CI had 4 months of lasting and progressive pain with radiation to the outer side of the lower leg.  There was no restriction of lumbar spine mobility and fingertip to floor distance was 10 centimeters (4 inches).  Toe and heel walk and knee bending were carried out.  Lasègue’s test (to determine nerve root irritation) on the left was positive.  There was no paresis (muscle weakness caused by nerve damage) and no sensory disturbances.  There was pain on pressure in the lower spine region and over the pelvitrochanteric (hip) musculature.  The examiner indicated this was “a case of an intervertebral-disk contingent L5 root irritation syndrome on the left,” noting MRI findings of “a discrete medial protrusion at L4/L5 with slight tangency of the L5 root in the left recess,” without neurological deficits and “with pains reversing in the meantime through anti-inflammatory therapy.”  He noted there was no indication for neurosurgical intervention.  At a physical therapy examination on 5 May 2004, 9 months after separation it was noted that the CI’s right leg appeared to be 2 centimeters (approximately 3/4 inch) longer that the left.  There was lumbar hyperlordosis; and lumbar rotation to the left was painful.  The examiner noted that since 14 April 2004 the low back pain was almost free of symptoms with a program consisting of stretching and strengthening exercises.   At the remote 23 March 2007 VA Compensation and Pension (C&P) evaluation, 43 months after separation, the CI’s spine ROM was normal and there was no loss of motion with repetition.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic low back pain 10%, coded 5293-5299-5295 (intervertebral disc syndrome-lumbosacral strain), citing pain with movement.  The VA rated the back condition 0%, coded 5243 (intervertebral disc syndrome), based on the STR citing a non-compensable evaluation.  

The panel agreed that a 10% rating was justified for characteristic pain on motion, albeit was subjective according to the PEB rather than objective.  There was no muscle spasm on extreme forward bending, loss of lateral spine motion, unilateral, in standing position to warrant a 20% rating.  However, the panel noted the CI had a forward flexion of 60 degrees that could be considered moderate IAW code 5292 (spine, limitation of motion of, lumbar) and could warrant a 20% rating, although 8 months post-separation the CI was able to flex within 10 cm of the floor, which is within normal limits.  However, the 60 degrees of flexion was more proximate to separation than the examination 8 months post-separation.  There was no documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes which would provide for a higher rating under that formula (for IVDS).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority recommends a disability rating of 20% for the chronic low back pain condition, coded 5292.  

BOARD FINDINGS:  In the matter of the chronic low back pain condition, the panel majority recommends a disability rating of 20%, coded 5292 IAW VASRD §4.71a.  The single voter for dissent recommended no change and did not elect to submit a minority opinion.  There were no other conditions within the Board’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	5292	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150617, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

	

AR20170009043, XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	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