RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2015-01373
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070709

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Power Generation Equipment Repairer, medically separated for “chronic low back pain with atraumatic onset,” with a disability rating of 10%.  

CI CONTENTION:  His condition continues to worsen and impact his daily life.  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 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 - 20070523	VARD - 20130508	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain with Atraumatic Onset	5299-5237	10%	Back Condition Lumbar Spine	5237	NSC	20130508	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Chronic Low Back Pain with Atraumatic Onset.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic low back pain condition began in December 2005 after running.  The CI denied any specific injury or trauma.  Diagnostic imaging studies (MRI) 3 October 2006 showed degenerative disc disease at L1.  There was circumferential bulging annulus (bulging intervertebral discs) at L3-4 and L4-5.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic mechanical low back pain,” for PEB adjudication.  

At the 4 December 2006 Physical Therapy evaluation, performed 7 months prior to separation, the CI reported low back pain.  Physical examination showed normal strength and reflexes and straight leg raise (SLR) testing was negative for radiating symptoms.  There was tenderness to palpation and muscle spasm.  Muscle strength was normal.  The thoracolumbar range of motion (ROM) was limited by pain to 70 degrees forward flexion (normal 90) with extension and lateral flexions of 20 degrees (normal 30 degrees); rotation measurements were not present.  

During the MEB NARSUM examination dated 1 May 2007, 2 months prior to separation, the CI reported intermittent low back pain described as dull, achy, rated 6-8/10 scale and was aggravated by bending, running, jumping, or lifting greater than 30 pounds.  The pain was relieved by rest and medication (Motrin and Flexeril).  The pain prevented him from performing physical training and performing his duties as a mechanic; he was unable to mount or dismount tactical vehicles or wear combat equipment, such as load bearing equipment.  Physical examination showed normal strength and reflexes and straight leg raise (SLR) testing was negative for radiating symptoms.  There was tenderness to palpation.  The ROM was restricted by pain to forward flexion of 45 degrees (normal 90) with combined ROM of 135 degrees (normal 240).  

There was no VA Compensation and Pension (C&P) evaluation performed proximate to separation.  The first C&P was over 5 years after separation and documented a normal back evaluation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic low back pain with atraumatic onset condition 10%, coded 5299-5237 (lumbar spine strain), citing tenderness and limitation of motion from pain.  The VA rated the chronic low back pain with atraumatic onset condition as not service connected, coded 5237 (lumbar spine strain), based on the VA C&P examination greater than 5 years after separation, citing evidence did not reflect a chronic back condition that was due to or aggravated by service.  

In assigning probative value to these somewhat conflicting examinations, the panel noted that the PT examination was incomplete and further from the date of separation than the NARSUM examination.  The VA examination’s probative value was judged to be compromised by its remoteness (over 5 years) from the date of separation.  Therefore, based on all evidence and the associated conclusions just elaborated, panel consensus was that preponderant probative value should be assigned to the MEB ROM examination.  The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees) reported on the MEB NARSUM examination.  

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the chronic low back pain condition, coded 5299-5237.  

BOARD FINDINGS:  In the matter of the chronic low back pain condition, the panel unanimously recommends a disability rating of 20%, coded 5299-5237 IAW VASRD §4.71a.  

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 with Atraumatic Onset 	5299-5237	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

AR20170007563, XXXXXXXXXXXXXXXXXX

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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 to 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,