RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  pd-2015-01577
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20090716

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Army National Guard, Radio/Communications (COMSEC) Repairer, medically separated for “chronic low back pain” with a disability rating of 10%.  

CI CONTENTION:  The CI made no specific contention.  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 panel 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 - 20090605	VARD - 20091222	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Traumatic Retrolishesis of the Lumbosacral Spine with L5-S1 Disk Disease	5239	20%	20091008	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY: 

Chronic Low Back Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back condition began in August 2000 after lifting a computer and was further aggravated in June 2004 following a fall.  She eventually deployed to Iraq where her back condition was further exacerbated by the wearing of her IBA.  Radiographic imaging performed in late 2008 revealed mild degenerative disc disease (DDD) of the lumbosacral spine with [slippage] of L5 with respect to S1.”  

The 27 February 2009 MEB NARSUM examination, 5 months prior to separation, noted a 3/10 baseline low back pain (LBP) without a radicular component and aggravated by lifting and or running.  Her physical examination (PE) revealed muscular tenderness about the lumbar spine and a normal gait.  Thoracolumbar range of motion (ROM) was minimally decreased and painful.  Motor strength, sensory, and reflexes were normal.  

At the 8 October 2009 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported continuous LBP at a 3/10 with morning stiffness.  Pain worsened to 8-10/10 after a long work day.  She additionally endorsed the use a cane or crutches while getting over the stiffness.  Her VA PE revealed what the examiner noted “a remarkable straightening of the normal lumbosacral lordosis.”  There was tenderness without spasm about the lower lumbar spine.  Thoracolumbar ROM was limited and painful noting forward flexion to 40 degrees (normal 90), extension 20 degrees (normal 30), lateral flexion of 20 degrees to the right and 25 degrees to the left (normal 30 degrees each side).  Bilateral rotation of the lower spine was normal.  The combined ROM was 165 degrees (normal 240).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic LBP condition at 10%, coded 5237 (lumbar spine strain), citing limitation of combined ROM.  The VA rated the chronic LBP condition at 20% coded 5239 (spondylolisthesis or segmental instability), based on the C&P examination 3 months after separation, citing limitation of motion to 40 degrees forward flexion.  The panel agreed that a 20% rating, but no higher, was justified for limitation of thoracolumbar flexion to 40 degrees, (greater than 30 degrees but not greater than 60 degrees) as reported on the 3 month post-separation VA examination.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the recommends a disability rating of 20% for the chronic LBP condition, coded 5237.  

BOARD FINDINGS:  In the matter of the chronic LBP condition, the panel unanimously recommends a disability rating of 20% coded 5237 IAW VASRD §4.71a.  There were 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 «ApplicationDate», w/atchs
Exhibit B.  Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record 

AR20170008540, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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