RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01880
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060317

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Tracked Vehicle Mechanic, medically separated for “chronic back pain,” with a disability rating of 0%.

CI CONTENTION:  “Review all conditions.”  The CI attached a two page memo to the application which was reviewed by Board members.  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 - 20060204	VARD - 20060410	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5237	0%	Chronic Lumbosacral Strain	5237	10%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:  

Chronic Back Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in February 2005 after falling.  An MRI in August 2005 showed minor degenerative changes.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty. The MEB forwarded “lumbar pain” for PEB adjudication.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated November 2005, 4 months prior to separation, the CI reported chronic lower back pain.  Physical examination showed tenderness to palpation and painful motion.  Thoracolumbar range of motion (ROM) measurements performed by physical therapy (PT) on 8 November 2005 showed flexion of 90 degrees (normal 90) and a combined ROM of 225 degrees (normal 240) after repetition.  Painful motion was reported.  At the MEB NARSUM examination on 17 November 2005, 4 months prior to separation, the CI reported constant and severe pain.  She stated she could not sit for long periods of time or stand without having to change positions.  Physical examination showed a slow and stiff gait.  Reflexes, sensory and motor were all normal.  Straight leg raise testing was also normal.  She was noted and observed to have a sciatic list to the left.  Spasms were not recorded, but she did have superficial tenderness to palpation in her lumbar spine.  The examiner referred to the PT ROM noted above.  The CI did not have a VA Compensation and Pension (C&P) evaluation and the STRs were used for rating purposes.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 0%, coded 5237 (lumbar spine strain), citing 4/5 Wadell’s signs.  The VA rated the back condition 10% coded 5237 based on the STR citing tenderness to palpations and passive ROM.  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 the alternate VASRD formula (for IVDS).  There was no evidence of an associated unfitting radiculopathy for consideration of a separate peripheral nerve rating; however, it was noted that guarding (listing to the left) associated with an abnormal gait (slow and stiff) was present on the NARSUM examination.  The Board concluded this was a sufficient basis for a 20% rating.  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 5237.  

BOARD FINDINGS:  In the matter of the low back condition, the Board majority recommends a disability rating of 20%, coded 5237 IAW VASRD §4.71a.  The single voter for dissent recommended modification to 10% and did not elect to submit a minority opinion.  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 Back Pain	5237	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150707, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170004064, 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 to 20% 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 record of proceedings, majority recommendation and minority opinion (copy enclosed).  I reject the Board’s majority recommendation and accept the minority opinion to modify your disability rating to 10%.  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