RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01409
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060206

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Petroleum Supply Specialist, medically separated for “chronic low back pain,” with a disability rating of 0%.

CI CONTENTION:  The CI requests that all conditions be considered.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited 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.  Any conditions outside the Board’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 Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’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 Board 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 Board 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 - 20051130	VARD - 20061118	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain…	5299-5237	0%	Lumbar Strain	5237	0%	20061023	
High Blood Pressure	Not Unfitting	Hypertension	7101	10%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back pain began in early 2004 after heavy lifting.  The CI reported low back pain without radiation or neurological symptoms.  Lumbar spine X-rays in January 2005 were normal.  Multiple exams in the year before the MEB NARSUM examination noted normal range of motion (ROM) or slightly decreased ROM, with normal gait and no muscle spasm.  A physical therapy evaluation in April 2005 noted flexion of fingers to within 8 inches of the floor (approximately 70 to 80 degrees – normal 90), 25% decrease in extension and normal lateral bending and rotation.  Orthopedic evaluation in May 2005 noted “touches his toes on forward flexion” (equivalent to 90+ degrees of flexion), with combined ROM at 225-230 degrees (normal 240).  Provocative testing for nerve root impingement was negative bilaterally.  The CI was determined to meet retention standards and he requested a second opinion regarding fitness for duty.  The orthopedic second opinion FFD exam on 27 September 2005 showed normal gait and posture with normal movement of all extremities and the diagnosis was lumbago (generalized low back pain) that precluded worldwide deployment and a MEB was initiated.  The MEB forwarded “mechanical low back pain” for PEB adjudication.  

During the MEB examination (recorded on DD Forms 2807 and 2808) dated 23 August 2005, 5 months prior to separation, the CI reported low back pain with occasional spasms but no radicular symptoms.  Physical examination showed tenderness of the lower back and negative tests for nerve root impingement.  Back ROM was recorded as painful, with reduced ROM in flexion.  Neurological examination was normal.  The MEB NARSUM examination on 18 October 2005, 4 months prior to separation, noted complaints of low back pain rated 8/10 intensity with no lower extremity weakness or bowel or bladder symptoms.  Physical examination showed tenderness of the low back and mild loss of lordosis (the normal curvature of the spine), but no evidence of scoliosis (abnormal lateral curvature of the spine) and no obvious gait changes.  There was no muscle spasm and reflexes were normal.  At the time of the physical therapy (PT) appointment 10 days later on 28 October 2005, the CI reported low back pain rated 6/10 in severity.  On examination, lumbar ROM was measured with flexion at 55 degrees and combined ROM at 155 (both after three repetitions), with motion limited by pain.  

At the 23 October 2006 VA Compensation and Pension (C&P) evaluation, performed 9 months after separation, the CI reported episodic low back pain (2-3 times per week), rated 7/10 in severity, with no associated radiation to the lower extremities and no bowel or bladder symptoms.  This pain was exacerbated by prolonged standing, bending, or lifting over 50 pounds, and relieved by rest or avoidance of exacerbating activities, but did not interfere with civilian job as corrections officer and had not caused any missed workdays in the previous year.  Physical examination showed gait neurologic examination, and curvature of the spine to all be normal.  ROM was reported as flexion at 80 degrees and combined 230 after 3 repetitions, with painful motion.  Provocative testing for nerve root irritation was negative.  Radiographic studies of the lower spine were normal.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 0%, coded 5299-5237 (analogous to lumbosacral strain), citing tenderness and pain with motion.  The VA used the 5237 code but rated the back condition 10%, based on the VA C&P examination 9 months after separation, citing pain on motion.  The Board agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) and/or combined ROM (greater than 120 degrees but not greater than 235 degrees) reported at serial exams in the STR and the VA exam.  The PT ROM evaluation for the MEB recorded documented flexion of “greater than 30 degrees but not greater than 60 degrees” and is the single piece of evidence that provided support for a 20% rating, however, it was inconsistent with all other ROM evidence in the record.  There was no evidence in record that TL ROM was frequently or permanently limited to not greater than 60 degrees.  The Board concluded the total ROM evidence in record most nearly approximated the 10% rating criteria rather than the 20%.  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 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 recommends a disability rating of 10% for the chronic low back pain, coded 5237.  

Contended PEB Condition:  High Blood Pressure.  The Board’s main charge is to assess the fairness of the PEB’s determination that the high blood pressure condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement and was judged to not fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the chronic low back pain, the Board unanimously recommends a disability rating of 10%, coded 5237 IAW VASRD §4.71a.  In the matter of the contended high blood pressure, the Board unanimously recommends no change from the PEB determination as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  The Board 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	5299-5237	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150616, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170006464, 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 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,