RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01967
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050928

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Multichannel Transmission Systems Operator, medically separated for “chronic back pain, without neurologic abnormality” with a disability rating of 10%.  

CI CONTENTION:  The CI contends for his unfitting and current back condition and a condition not identified by either the MEB or PEB.  The CI’s 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 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 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 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 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 - 20050803	VARD - 20060524	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain Without Neurologic Abnormality… 	5299-5237	10%	Degenerative Facet Disease L3-L4 	5243	0%	20060327	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Back Pain, Without Neurologic Abnormality.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI suffered an atraumatic onset of back pain during a 2003 deployment to Iraq.  This was associated with sporadic complaints of right leg (sometimes bilateral) pain radiation and sensory complaints, although there was no STR evidence for subjective weakness.  There were multiple normal neurological examinations (5/5 bilateral motor strength) evidenced in STR clinical entries with none to the contrary.  Imaging demonstrated degenerative disc disease (L2-4, “very slight” bulging at L3/4 without neural encroachment), and revealed an incidental diagnosis of persistent ring apophysis (a developmental abnormality affecting the attachment of the vertebrae to the discs).  There was ample STR documentation of grossly normal range of motion (ROM), although there were earlier entries that noted non-specifically decreased ROM, and there were no STR entries that indicated significant ROM limitation.  There was STR documentation of normal gait and spinal contour with no contrary entries, and there was no STR documentation of incapacitating episodes.  Surgery was not indicated and conservative treatment did not result in sufficient improvement to allow unrestricted duty.  The MEB forwarded ““symptomatic persistent ring apophysis causing mechanical low back pain” for PEB adjudication.  The NARSUM examination on 8 March 2005 (6 months before separation) documented constant pain rated 5/10, with “occasional” paresthesias but no other radicular symptoms, that was worsened by prolonged sitting or standing, lifting, and load bearing.  The physical examination recorded a normal gait, tenderness, and normal neurological findings (5/5 strength, intact sensation, symmetric reflexes).  Measured ROM by the NARSUM examiner was flexion to 75 degrees (normal 90) with a combined ROM of 215 degrees (normal 240).  Measured ROM for the MEB by physical therapy (20 June 2005, 3 months before separation) was flexion to 65 degrees with a combined ROM of 215 degrees.  A VA Compensation and Pension (C&P) examination on 27 March 2006 (6 months after separation) documented constant pain (unelaborated) with occasional right leg radiation that was exacerbated by “prolonged standing, walking, bending, and lifting.”  The physical examination recorded a normal gait and spinal contour, the absence of tenderness or spasm, and normal neurological findings (motor, sensory, and reflexes).  Measured ROM was normal in all planes, specifying the absence of painful motion or degradation with repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating under code 5299-5237 (analogous to lumbar strain) cited the VASRD §4.71a criterion of combined ROM.  The VA’s 0% rating under code 5243 (intervertebral disc syndrome) cited the lack of any ratable criterion based on the C&P evidence.  There was no ROM evidence supporting a rating higher than 10%, no evidence for abnormal gait or spinal contour to support a 20% rating, and no documentation of incapacitating episodes that would provide for a higher rating under that formula.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication of the lumbar condition.    

PANEL FINDINGS:  In the matter of the lumbar spine condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel therefore recommends that there be no re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150715, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170005301, XXXXXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.

Sincerely,					      
						      					
Enclosure