RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02219
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060430

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a mobilized Army National Guard E4, Automotive Fuel and Electrical Systems Repairer, medically separated for “chronic low back pain” with a disability rating of 10%.  

CI CONTENTION:  The CI does not agree with the FPEB rating percentage.  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 - 20060322	VARD - 20061106	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Lumbar Spine Problem, L4-L5	5242	NSC	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP).  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s lower back condition began in February 2005 after heavy lifting.  Radiographic studies on 18 February 2005 indicated a herniated disc at L4-5 causing central and right sided foraminal stenosis, and contacting right L5 nerve root in the lateral recess.  

At the 15 July 2005 Physical Medicine and Rehabilitation (PM&R) evaluation, 9 months prior to separation, the CI reported central LBP that radiated to the left leg at times and occasional numbness or tingling in the posterior aspect of the left thigh with sitting.  The CI recounted that he was sometimes able to relieve his pain by “popping” his back.  The physical examination revealed forward flexion to 20 degrees (normal 90) which caused pain.  The examiner asked him to flex as far forward as he could and he was able to flex to 40 degrees and extend to 10 degrees (normal 30).  There was tenderness to palpation over the lower portion of the lumbar spine and painful palpable spasm of the mid to lower left sided lumbar paraspinal muscles.  

A 19 November 2005 electromyographic study, 5 months prior to separation, the study was negative for signs of radiculopathy.  

The 22 December 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of persistent lower back pain and intermittent left leg pain radiation and left thigh paresthesia.  The CI reported no symptoms into right leg.  The CI also reported he was unable to carry load bearing equipment (LBE), body armor, rucksack over uneven terrain, unable to lift or carry more than 20 pounds, unable to perform APFT run or sit-ups, and that he had difficulty walking more than 100 yards or putting on boots.  The physical examination showed “marked limitation of forward flexion” and referred to the Physical Therapy (PT) examination on 14 December 2005.  That examination recorded range of motion (ROM) measurements after 3 repetitions as forward flexion of 20 degrees (90 normal).  Muscle spasm and pain on movement was noted.  The therapist also performed straight leg raises on both sides which were inconsistent with the forward flexion noted in that exam.  The physical therapist opined that the “lumbar flexion measurement taken this date is not considered valid for rating purposes.”  

The CI failed to present for the scheduled 20 October 2006 VA Compensation and Pension (C&P) evaluation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back pain 10%, coded 5237 (Lumbosacral or cervical strain), citing tenderness to palpation of paraspinous muscles.  On 6 November 2006, the VA did not service connect the low back pain coded 5242 (Degenerative arthritis of the spine), based on the STR, citing no objective medical evidence showing a chronic lumbar spine disability.  

The panel noted that the ROM measurements performed at the 14 December 2005 PT evaluation for the MEB were similar to those recorded at the PM&R consult 15 July 2005 prior to the examiner suggesting that he try to bend further.  In light of the PT’s comments that his evaluation is not considered valid for rating purposes, the panel used the PM&R evaluation for ROM measurements.  There was forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees to justify a 20% rating in the General Rating Formula for Diseases and Injuries of the Spine.  The panel agreed that there was no limitation of forward flexion of the thoracolumbar spine of less than 30 degrees to justify a 40% 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), or evidence of ratable peripheral nerve impairment which would provide for additional 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 low back pain, coded 5237.  

BOARD FINDINGS:  In the matter of the low back pain, 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	
Chronic Low Back Pain	5237	20%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150112, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170012129, 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