RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01504
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20051208

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

CI CONTENTION:  “Review all conditions.”  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 - 20051114	VARD - 20070430	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Low Back Pain	5237	0%	STR	
Lumbosacral Radiculopathy	Not Unfitting	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:

Chronic Low Back Pain.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in February 2004 after heavy lifting.  Magnetic resonance imaging studies on 22 February 2004 showed small central disk protrusion of L5-S1 without central canal stenosis.  CT scan of the lumbosacral spine on 7 July 2005 showed a small L5-S1 central disk protrusion which might have contacted bilateral S1 nerve roots, and a mild central canal stenosis secondary to diffuse bulging of the annulus and congenital small canal.  The CI declined invasive procedures for pain control and no surgery was recommended.

The 22 August 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of persistent and progressive lower back pain, with pain radiating down his left leg.  The CI denied any lower extremity numbness, dysesthesias, or weakness.  He was not using any medications for his back pain and he denied invasive procedures for pain control.  Physical examination showed a normal gait, normal strength, normal reflexes, normal sensation, negative straight leg raise test bilaterally, and negative Faber test bilaterally.  There was some mild to moderate muscular spasm of the lumbosacral spine bilaterally.  Range of motion (ROM) showed a flexion of 50 degrees (normal 90) and a combined ROM of 195 degrees (normal 240).  There was no sensory deficit and reflexes and muscle strength testing were normal.  Straight leg raise testing for radicular symptoms was negative.  

During the 22 September 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported recurrent back pain with numbness/tingling, that he could not do sit-ups or flutter kicks because of back pain, and that it hurt to run.  Physical examination showed ROM measurements for flexion of 50 degrees, and a combined ROM of 200 degrees.  There was no tenderness of the paraspinal aspect and there was mild bony tenderness at L4-S1.  There was no VA Compensation and Pension examination performed for this panel to review.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic low back pain condition 10%, coded 5237 (lumbosacral strain), citing “flexibility of the spine is limited by pain alone (no mechanical block),” with likely application of AR 635-40, B-29.  The VA rated the back condition 0%, coded 5237, citing that the CI did not report for a VA 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.  There was no evidence of intervertebral disc syndrome (IVDS) which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under that alternate VASRD formula.  There was no associated radiculopathy for separate peripheral nerve rating.  While the CI may have experienced radiating pain from the back condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  Lumbosacral radiculopathy is discussed under contended PEB conditions below.  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 5237.

Contended PEB Condition:  Lumbosacral Radiculopathy.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no objective evidence of a radiculopathy with functional impairment (such as weakness) that directly impacted fitness for duty.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel 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 condition, the panel unanimously recommends a disability rating of 20%, coded 5237 IAW VASRD §4.71a.  In the matter of the contended lumbosacral radiculopathy condition, the panel unanimously recommends no change from the PEB determination as not unfitting.  There are no other conditions within the panel’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	5237	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150602, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170009051, 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