RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02215
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050713

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

CI CONTENTION:  The CI’s back condition continues to worsen and negatively impacts daily activities.  Additionally, the CI contended his knees that were not identified by the MEB or PEB.  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 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 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 upon a 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 - 20050519	VARD - 20061028	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	0%	Mechanical Back Pain with Degenerative Joint Disease at L5-S1	5242	10%	20060825	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic LBP condition began in June 2003 and was attributed to the increased physicals demands of basic training without any specific injury or trauma.  Radiographic studies, on 26 January 2005, showed a narrowing of the L5-S1 disc space, with an otherwise normal lumbosacral spine.  There was no surgical indication.  

A 26 January 2005 MEB consultation, 6 months prior to separation, reported continued back pain that had not responded to conservative treatments.  The CI reported that he could not wear a rucksack due to pain and that he needed to sleep on his side in the fetal position in an effort not to exacerbate his pain.  He additionally related having regular pain while standing or sitting, although the pain was more pronounced with sitting.  Physical examination demonstrated no abnormal curvatures of the spine.  There was mild tenderness to palpation over the lumbar paraspinous muscles and painful motion.  

The 30 March 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of constant aching pain in the lumbar spine that was aggravated by standing for more than 5 minutes, lifting more than 40 pounds and wearing a backpack or body armor.  Physical examination showed a normal gait, no tenderness to palpation over the lumbar paraspinous muscles and painful motion.  The ROM measurements were recorded as forward flexion 80 degrees (normal 90) and a combined ROM of 225 degrees (normal 240).  

At the 25 August 2006 VA Compensation and Pension (C&P) evaluation, 13 months after separation, the CI reported constant pain that was achy in nature.  Pain was increased by lifting, standing more than 15-to-20 minutes and sitting.  The CI reported that he had taken no time off due to back pain over the previous year.  Physical examination showed a normal gait with no tenderness to palpation.  The ROM was recorded as forward flexion of 90 degrees with pain at 45 (normal 90) and a combined ROM of 225 degrees.  Repetitive motion did not cause further decrease in ROM of the thoracolumbar spine.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic LBP condition 0%, coded 5237 (lumbosacral strain), citing pain-limited motion, no spasm, deformity or tenderness to palpation.  The VA rated the “mechanical back pain with degenerative joint disease at L5-S1” condition 10% coded 5242 (degenerative arthritis of the spine), based on the VA C&P examination 13 months after separation, citing limitation of forward flexion with painful motion.  The panel agreed that a rating of 10%, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) or combined ROM (greater than 120 degrees but not greater than 225 degrees) reported on the NARSUM examination.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour to justify a higher, 20% rating.  There was also no documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes which would provide for a higher rating under that formula (for IVDS).  

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 LBP condition, coded 5242.  

BOARD FINDINGS:  In the matter of the chronic low back pain condition, the panel unanimously recommends a disability rating of 10%, coded 5242 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	5242	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150628, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170012126, 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