RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02093
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060504

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Animal Care Specialist, medically separated for “chronic low back pain,” 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 - 20060124	VARD - 20060615	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Thoracolumbar Spine, DDD	5242	20%	20060222	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Low Back Pain (LBP).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s LBP began after she turned her head and her neck cracked.  Of note, she had been seen in the ER 3 days earlier after hitting her head on a concrete wall while chasing a dog.  An MRI was significant for a herniated disc at L4-5 and a degenerative disc at L5-S1.  She was referred to chiropractic therapy and treated on a regular basis until separation.  On 3 October 2005, she was issued an L3 profile and entered into the MEB process.  The MEB DA Form 2697 and DD Form 2807 and 2808 examination was dated 26 October 2005.  The CI reported ongoing LBP with collapse of the right leg.  She noted that she had declined surgery.  On examination, she was found to have a positive test for nerve root irritation.  The neurological examination was normal.  The MEB NARSUM examination on 3 November 2005, 6 months prior to separation, noted no neurological complaints, but persistence of pain.  The physical examination showed limited but painless motion as charted below.  The neurological examination was normal.  Provocative testing for nerve root irritation was negative.  The MEB then forwarded “recalcitrant low back pain” for PEB adjudication.  

At the VA Compensation and Pension (C&P) evaluation performed on 8 February 2006, 3 months before separation, the CI reported constant pain radiating from the back to the right lower extremity accompanied with stiffness and weakness.  She reported that there had been several periods of incapacitation with one lasting 30 days and a total of 40 days.  The Board found that the CI had been placed sick in quarters one time, from 23-29 May 2005, following the initial injury.  The record does show that she was on light duty from the accident until near separation.  On examination, her gait was normal and she did not use an assistive device.  Muscle spasm was present.  Motion was limited and painful as charted below.  There was no evidence for an intervertebral disc syndrome.  Provocative testing for nerve root irritation was positive on the right.  X-rays of the lumbar spine showed degenerative disc disease at L4-5 and L5-S1 with straightening consistent with spasm.  A second C&P evaluation was completed on 22 February 2006, 2 weeks later, by the same examiner.  On examination, her gait was initially normal and then became mildly antalgic (abnormal secondary to pain) after she started walking.  The examination of the back was identical to that recorded at the prior visit.  There was a non-dermatomal loss of sensation over the right thigh consistent with meralgia paresthetica (abnormal sensation due to peripheral nerve injury.  The motor function and reflexes were normal.  

The ROM examinations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.  

Thoracolumbar ROM
(Degrees)	MEB ~6 Mos. Pre-Sep	VA ~3 Mos. Pre-Sep 	
Flexion (90 Normal)	45	55	
Combined (240)	-	185	
Comments	No pain with motion	Pain with flexion and extension.  Nml neuro except meralgia paresthetica	
§4.71a Rating	20%	20%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP condition 10%, coded 5237 (lumbosacral strain), citing ROM limited by pain.  The VA rated the LBP condition 20% coded 5242 (degenerative arthritis of the spine), based on the VA C&P examination 3 months before separation, citing a ROM of 55 degrees flexion with pain.  There was no evidence of incapacitating episodes sufficient to warrant consideration of a higher rating under the alternate VASRD rating formula (for IVDS).  There was no evidence of an associated unfitting radiculopathy for consideration of a separate peripheral nerve rating.  The Board agreed that a 20% rating was justified for limitation motion.  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 LBP condition, coded 5237. 

BOARD FINDINGS:  In the matter of the LBP condition, the Board unanimously recommends a disability rating of 20%, coded 5237 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	
Low Back Pain	5237	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150618, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

	

AR20170004079, XXXXXXXXXXXXXXXXXX

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,