RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02210
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 E5, Patriot Fire Control Operator, medically separated for “chronic non-radiating low back pain [LBP]” with a disability rating of 10%.  

CI CONTENTION:  “Review all conditions.”  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 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 - 20050217	VARD – 20050523	
Condition	Code	Rating	Condition	Code	Rating	Exam	
LBP	5237	10%	DDD, DJD, Lumbar Spine	5010-5243	20%	20050505	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

LBP.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s LBP condition began in 1998 and subsequently injured his back while working in the motor pool.  Imaging studies (MRI) of the spine revealed degenerative disc disease (DDD).  Despite treatment, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB. The MEB forwarded “degenerative disc disease at lumbar spine” for PEB adjudication.  

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

Thoracolumbar ROM
(Degrees)	PT~14 Mos. Pre-Sep	MEB~6 Mos. Pre-Sep	VA~2 Wks. Pre-Sep	
Flexion (90 Normal)	“FAROM in all directions”	20	55	
Combined (240)	240	90	180	
Comments	Painful motion,
No spasm,
Normal gait	Painful motion,
Spasm	Painful motion,
Spasm	
§4.71a Rating	10%	40%	20%	

The 3 November 2004 MEB NARSUM examination, 6 months prior to separation, noted complaints of back pain that worsened with lifting, pulling, standing and sitting for extended periods.  The CI also complained of tingling and numbness in the bottom of his feet.  The physical examination showed mild spasm which worsened with provocative motion.  The ROM values were outside the normal parameters as noted above.  At the 5 May 2005 VA Compensation and Pension evaluation, performed 2 weeks before separation, the CI reported taking Motrin and Flexeril for pain and muscle spasm relief.  The CI denied any corrective surgery.  The physical examination showed CI walking with a cane and experienced muscles spasms with movement.  The ROM values were outside the normal parameters as noted above that accompanied pain and stiffness, especially with flexion and extension.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP condition 10%, coded 5237 (lumbosacral strain), citing painful motion limited by pain.  The VA rated the LBP condition 20% analogously coded 5010-5243 (intervertebral disc syndrome), based on the C&P examination 2 weeks before separation, citing a lumbar spine flexion of 55 degrees.  The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees) and/or combined ROM not greater than 120 degrees) reported on the VA examination.  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.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the LBP condition, coded 5237.  

BOARD FINDINGS:  In the matter of the LBP condition, the panel unanimously recommends a disability rating of 20%, coded 5237 IAW VASRD §4.71a.  There are 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	
LBP	5237	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150731, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170010336, 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