RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02026
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070215

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Health Care Specialist, medically separated for “low back pain” with a disability rating of 0%.  

CI CONTENTION: The CI contends for sleep apnea and diabetes now.”  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 progression or complications of service-connected conditions after separation.  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 - 20070130	VARD - 20070626	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	0%	Lumbago with T8-9 and L5-S1 Herniation	5243	10%	20070626	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in April 2005 after no specific trauma.  Magnetic resonance imaging (MRI) studies of the spine on 6 April 2006 showed a small paracentral disc protrusion with cord abutment at T8-9.  A neurological consult on 14 November 2006, including electrodiagnostic testing (EMG/NCV), showed mild root irritability at L5-S1 without any acute radiculopathy.  Physical examination showed no gross focal finding on the neurological examination.   

The 19 December 2006 MEB NARSUM examination, 2 months prior to separation, noted complaints of back pain rated as high as 6/10.  He had difficulty falling asleep and was awakened a few times each night due to his back pain.  He stated he could no longer play golf or bowl.  He used NSAIDs and muscle relaxants several times a week for pain and Percocet (a narcotic) approximately once a week to help him sleep.  Physical examination showed thoracolumbar range of motion (ROM) measurements from physical therapy on 13 November 2006, with a flexion of 80 degrees (normal 90) and combined ROM of 225 degrees (normal 240) with painful motion on flexion.  Straight leg raises (SLR) was negative for radiculopathy and there was no tenderness to palpation.  

At the 26 June 2007 VA Compensation and Pension (C&P) evaluation, performed 7 months after separation, the CI reported back pain which had gotten worse since discharge from military.  He had virtually no sciatica issues although he continued to take medication for pain.  Physical examination showed no deformity or tenderness of the spine.  The CI had full ROM with pain at 80 degrees and strength was normal bilaterally.  SLR was negative for radiating symptoms while standing and sitting.  There were no neurological deficits noted.  The CI had painful ROM after repetitive testing.  Neurologic examination recorded negative Romberg testing.  The examiner stated “he is able to heel and toe walk without difficulty, able to tandem walk without losing his balance, sensory was grossly intact and DTR’s 2+ and symmetric.”  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back pain condition 0%, coded 5237 (lumbosacral strain), citing combined ROM greater than 235.  The VA rated the lumbago condition 10% coded 5243 (intervertebral disc syndrome).  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).  

The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) reported on the MEB NARSUM examination and for painful motion reported on both the MEB NARSUM and VA examinations.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% 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 chronic low back pain condition, coded 5237.  

BOARD FINDINGS:  In the matter of the chronic low back pain condition, the panel unanimously recommends a disability rating of 10%, 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	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150722, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170016855, 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