RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01468
BRANCH OF SERVICE:  Army 	   SEPARATION DATE:  20080516

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Military Police, medically separated for “chronic 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 panel’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 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 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 – 20090323	VARD  - N/A	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain with Demonstrated Retrolisthesis of L4-5	5239	10%	No VA Examination within 12 month Period for Adjudication	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

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 2002 in a Bradley vehicle while deployed to Qatar.  There was no specific injury or trauma.  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 MEB.  

On 18 December 2007 physical therapy (PT) measured repetitive (X3) range of motion (ROM) for the MEB.  The CI complained of 5/10 back pain at rest.  The back revealed no localized tenderness, muscle spasms, or guarding.  There was no abnormal gait due to muscle spasm, guarding, or abnormal spinal contour.  The goniometer/inclinometer measured thoracolumbar active ROM values were flexion of 80/83/85 (90 normal), extension of 55/50/50 (30), right lateral flexion of 32/34/35 (30), left lateral flexion of 35/35/40 (30), right rotation of 64/67/66 (30), and left rotation of 42/43/46 (30) and corrected combined of 235 (240) degrees.  Left rotation was limited due to pain.  

In the 3 January 2008 NARSUM, 4 months before separation, the CI complained of chronic low back pain which did not radiate to his legs.  He denied radicular pain, anesthesia (loss of sensation), paresthesia (abnormal sensation, tingling, burning, prickling), bowel problems, or bladder problems.  The back examination revealed tenderness to the right of L5-S1 and muscle spasms.  Spine active ROM was flexion of 60 (with pain in the lumbar area and into his hip) and extension of 10 (with pain into the thoracolumbar area) degrees.  Strength, sensation, and deep tendon reflexes (DTRs) were normal and pathologic reflexes were absent.  The X-rays revealed degenerative disc disease with retrolisthesis (posterior displacement of vertebra) of L4 on L5 (< ¼ of the vertebral body).  There was no VA examination in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 5239 code (spondylolisthesis or segmental instability) citing chronic low back pain, retrolisthesis of L4 on L5, ROM, tenderness, spasm, normal strength, normal sensation, and no radicular signs.   The PT for MEB ROM values were consistent with the 10% rating (flexion of greater than 60 degrees but not greater than 85 degrees; or a combined ROM of greater than 120 degrees but not greater than 235 degrees of the thoracolumbar spine).  The higher 20% rating would require (flexion of greater than 30 degrees but not greater than 60 degrees; or a combined ROM of not greater than 120 degrees of the thoracolumbar spine).  While the NARSUM examination documented tenderness and spasm, proximate examinations revealed no evidence of abnormal spinal contour or abnormal gait.  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.  Other routes to a rating higher than the PEB’s 10% were considered, but there was no evidence of additional functional loss from repetitive use to warrant application of VASRD §4.45.  The panel agreed a 10% rating was supported based on VASRD §4.40 (functional loss) or §4.59 (painful motion).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the low back condition.  

BOARD FINDINGS:  In the matter of the low back condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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/atchs
Exhibit B.  Service Treatment Record

AR20170008510, 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.