RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01771
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050515

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Chemical Operations Specialist, medically separated for “chronic subjective low back pain [LBP],” 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 - 20050324	VARD - 20050615	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Subjective LBP	5299-5242	10%	Degenerative Disc Disease Lumbosacral Spine, L3-4, L4-5	5243	20%	20050517	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Subjective LBP Diagnosis.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in August 2004, while deployed, when he experienced a sudden onset of pain after performing sit-ups during a physical fitness test.  Several days later, just prior to leave in September 2004, the CI was doing his own individual physical fitness training when he felt a pop in his lower back which significantly aggravated his back pain.  He was initially treated with medications; however, on 20 September 2004, the CI’s symptoms worsened and he returned to sick call.  Magnetic Resonance Imaging (MRI) on 20 September 2004, showed mild degenerative disk changes, with a small diffuse disk bulge at L3-L4.  A physical therapy (PT) evaluation on 24 September 2004 noted normal sensory and motor exams with a positive straight leg raise testing to elicit radicular symptoms on the right.  Diskogram studies on 16 November 2004 showed concordant pain at the L3-L4, L4-L5, and L5-S1 disk levels.  In December 2004, orthopedic evaluation noted DDD and the CI was determined not to be a surgical candidate.  The MEB forwarded “lumbar degenerative disk disease” for PEB adjudication. 

At the MEB examination (recorded on DD Forms 2807 and 2808) dated January 2005, 4 months prior to separation, the CI reported right sided LBP.  Numbness and tingling in the right leg were reported with back pain.  Physical exam showed pain to palpation around L3-L5, positive straight leg raise right side, and motor strength at 5/5.  CI was unable to toe walk on the right.  

The MEB NARSUM examination on 8 February 2005, 3 months prior to separation, noted complaints of constant back pain rated 6-7/10.  Pain was described as a burning, stinging pain that occasionally radiated to the middle of the right thigh, but never below the knee, with numbing sensation in the right lower extremity, but no constant motor or sensory changes.  Medications included pain medication and a muscle relaxer.  Pain was relieved by muscle relaxer and rest.  Functional limitation included wearing body armor, climbing in and out of tactical vehicles, lifting heavy items, and participating in physical training.  Physical examination showed normal gait and posture.  The CI had difficulty with flexion and extension due to pain.  Lower extremity strength, sensation, and reflexes were normal and straight leg raise was negative.  Physical therapy measured range of motion (ROM) for the MEB on 18 March 2005 was flexion 55 degrees (normal 90) and combined ROM 185 degrees (normal 240) after 3 repetitions

At the 15 June 2005 VA Compensation and Pension (C&P) evaluation, performed at separation, the CI reported daily non-radiating LBP.  Right lower extremity symptoms had resolved.  Medications included daily narcotic pain medication at bedtime and muscle relaxer weekly.  A brace was prescribed but not worn the day of the exam.  The CI reported no incapacitation and routine daily activities were not impaired by his back pain.  Physical examination showed normal posture and gait and there were normal curves of the spine.  There was tenderness to palpation of the lumbar spine and objective evidence of painful motion without spasm or weakness.  Motor, sensory, and deep tendon reflexes were intact to lower extremities.  Thoracolumbar ROM was flexion of 60 degrees and combined ROM of 190 degrees, with painful motion.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5299-5242 (analogous to degenerative arthritis of the spine), citing range of motion limited by pain.  The VA rated the back condition 20% coded 5243 (Intervertebral disc syndrome), based on the VA C&P examination at separation, citing forward flexion.  The Board agreed 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 PT MEB and VA examinations.  There was no associated radiculopathy for separate peripheral nerve rating.  There was no documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes which would provide for a higher rating under the IVDS formula.  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).”  There was no objective evidence of a radiculopathy with functional impairment (such as weakness) that directly impacted fitness for duty.  The Board concluded 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 Board recommends a disability rating of 20% for the back condition, coded 5243.  

BOARD FINDINGS:  In the matter of the back condition, the Board unanimously recommends a disability rating of 20%, coded 5243 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

The Board 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 Subjective Low Back Pain	5243	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150701, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170005258, 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