RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX
	CASE:  PD-2015-01681
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050601

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Communication Specialist, medically separated for “chronic back pain,” with a disability rating of 0%.

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 - 20050315	VARD NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5237	0%	No VA Examination in Evidence	
Patellofemoral Pain Right Knee	Not Unfitting		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Back Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was initially seen for low back pain (LBP) in 1994 and treated with medications.  He was seen several more times for LBP over the next few years, but was able to complete airborne training.  On 1 September 2004, he reported a 3-year history of LBP without clear antecedent trauma.  No specific abnormalities were noted on the examination.  An X-ray of the lumbar spine showed a Schmorl’s node at T12-L1 (a vertical rather than horizontal protrusion of the disc).  He was treated with medications, duty restrictions, and referred for chiropractic treatment.  An MRI of the lumbar spine on 9 September 2004 showed multilevel degenerative disc disease (DDD) and degenerative joint disease (DJD) without herniation.  Impingement of the nerve roots or cord was not documented.  Congenital spinal stenosis was noted (narrowing of the spinal canal).  In flight medicine on 9 December 2004 he reported pain radiation to the right leg.  On examination, he had a normal gait and neurological examination.  He was then evaluated in orthopedics on 23 December 2004.  His examination was stable with a normal gait and neurological examination.  Atrophy was absent.  Provocative testing for nerve root irritation was positive on the right.  He was unable to meet duty requirements and identified for an MEB.  The CI was evaluated in physical therapy (PT) on 31 January 2005 for continued treatment.  He endorsed LBP radiating to both legs.  He was able to exercise on an elliptical and use light weights.  On examination, he was noted to have normal motor function and reflexes.  The neurovascular examination was recorded as normal.  Tenderness was present, but atrophy absent.  The range of motion (ROM) was noted to be for the lumbar spine (vice thoracolumbar spine) and showed a flexion of 60 degrees and combined ROM of 130 degrees.  

The MEB NARSUM examination was accomplished in orthopedics on 7 February 2005, 4 months prior to separation.  The CI reported a 3 year history of LBP, since an injury during a parachute jump, which radiated to the lower extremities.  Treatment including medications, duty restrictions, chiropractic manipulation, and PT had failed to improve the pain sufficiently for return to duty.  On examination, he was in no distress.  Tenderness was absent.  The neurological examination was normal.  The ROM was limited by pain.  It was measured with an inclinometer rather than a goniometer and was for the lumbo-sacral spine rather than the thoracolumbar spine.  Flexion was limited to 40 degrees and the combined ROM was 180 degrees.  This was also not VASRD compliant.  Signs of non-organic pain were absent.  There was not a VA evaluation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic back pain condition 0%, coded 5237 (lumbosacral strain), stating that the CI did “not meet the minimum rating criteria.”  There was not a VA rating in evidence.  The panel noted the NARSUM examination provided ROM values for the lumbar spine and used an inclinometer.  The VASRD (§4.71a, Plate V) specifies that a goniometer be used to measure the thoracolumbar ROM, not just the lumbar or lumbosacral ROM.  The examiner reported a lumbar flexion of 40 degrees.  The normal flexion for the lumbar spine is approximately 60 degrees.  The PT evaluation on 31 January 2005 noted lumbar flexion of 60 degrees.  The panel did not find valid thoracolumbar ROM measurements for either the combined ROM or for flexion to support a rating greater than 0% under VASRD §4.71a.  Painful motion was documented though and supported a 10% rating IAW VASRD §4.59 (painful motion).  The panel also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  While there were symptoms of radiating pain documented in the treatment records, the examinations indicated normal strength, sensation, reflexes, and gait.  The presence of an unfitting radiculopathy at separation is not supported by the evidence.  The panel therefore concluded that an additional disability rating was not justified on this basis.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the back condition, coded 5237.  

Contended PEB Conditions:  Patellofemoral Pain Right Knee.  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 or implicated in the commander’s statement.  It was judged to meet 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 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 back condition, the panel unanimously recommends a disability rating of 10%, coded 5237 IAW VASRD §4.71a.  In the matter of the contended patellofemoral pain right knee condition, the panel unanimously recommends no change from the PEB determination as not unfitting.  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 Back Pain	5237	10	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150624, w/atchs
Exhibit B.  Service Treatment Record

AR20170008784 , 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,