RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01417
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041116

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

CI CONTENTION:  “Review all conditions.”  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 - 20041007	VARD - 20041201	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5299-5237	10%	Spondylolysis L4-5 with Degenerative Disc Disease	5242	10%	20041103	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the low back pain (LBP) condition began in September 1999 without any specific injury or trauma.  Lumbar spine X-rays showed slight L4-L5 disk space narrowing with no spondylolysis (fracture/degeneration/deficient development of vertebral component) or spondylolisthesis (forward displacement of vertebra after a fracture).  A nuclear medicine bone scan was normal and showed no evidence of lumbosacral spine, or sacroiliac joint, abnormality.  Despite 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 an MEB.  The MEB forwarded “low back pain secondary to left spondylolysis without spondylolisthesis” for PEB adjudication.  
At the 5 September 2003 orthopedic appointment the CI reported 2-5/10 LBP without radiculopathy (nerve root irritation or injury) symptoms.  The CI was able to run 2 miles a day.  The back examination for range of motion (ROM) recorded flexion of 90, extension of 30, and side bending of 30 degrees.  The straight leg raise [SLR] tests (to assess for herniated disc causing sciatic nerve root [L5-S1] radiculopathy) were negative.  Strength, sensation, and deep tendon reflexes (DTRs) were normal.  The 20 July 2004 MEB NARSUM examination, 4 months before separation, noted complaints of LBP.  The physical examination documented a gait that was not antalgic (assuming a gait or posture to lessen pain) and the CI was able to toe and heel walk.  The examiner noted that the CI was able to forward bend to within 25 cm of the floor, which is approximately 70-80 (90 normal) degrees, and observed paravertebral muscle spasm bilaterally.  The SLR tests were negative and the neurological examination revealed no evidence of radiculopathy.  Strength, sensation, and DTRs were normal.  A 20 July 2004 lumbar spine X-ray showed anatomic alignment, well-preserved intervertebral disk spaces, no significant degenerative changes, no evidence of spondylolisthesis, and left L5 spondylolysis.  On 20 July 2004 physical therapy (PT) measured repetitive ROM for the MEB.  Trunk active ROM was flexion of 67/67/68 (90), extension of 10/8/8 (30), right lateral flexion of 22/20/19 (30), left lateral flexion of 17/17/18 (30), right rotation of 22/21/26 (30), left rotation of 26/26/24 (30), and an average combined ROM of 170 (240) degrees.  

At the 3 November 2004 VA Compensation and Pension (C&P) examination, 13 days before separation, the CI reported  developing pain after light jogs at his own pace.  The physical examination documented, “Posture and gait are normal.  No kyphosis [posterior spine curvature], lordosis [anterior spine curvature], or scoliosis [abnormal lateral spine curvature].”  The CI was able to toe, heel, and tandem walk.  The lumbar spine examination revealed lordosis with no tenderness or paraspinal muscle spasms.  Lumbar spine active ROM after five repetitions was flexion of 63 (95), extension of 12 (35), right lateral flexion of 29 (40), left lateral flexion of 31 (40), right rotation of 20 (35), and left rotation of 22 (35) degrees.  The SLR tests were negative.  Strength, sensation, pulses, and DTRs were normal and pathologic reflexes were absent.  The functional assessment noted the CI could walk up to 3 miles without any pain, but could not easily run the required 2 miles, nor wear a flak jacket and backpack.  He could otherwise undertake all other activities of normal daily living.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5237 (lumbosacral strain), citing the condition existed prior to service but was compensable under 10 USC 1207A, which grants compensability after a minimum of 8 years of service.  The VA also rated the back condition 10%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination 13 days before separation.  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 combined ROM (greater than 120 degrees but not greater than 235 degrees) based upon the ROM in the orthopedic, PT, NARSUM, and VA C&P examinations.  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.  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 back condition.  

BOARD FINDINGS:  In the matter of the back 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 20150617, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170011805, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

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,