RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02235
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081127

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Indirect Fire Infantry, medically separated for “chronic low back pain” with a disability rating of 10%.  

CI CONTENTION:  The CI contends he continues to have back pain.  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 - 20080815	VARD - 20090401	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Piriformis Syndrome (Back Pain)	5237	20%	20080827	
COMBINED RATING:  10%	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 low back pain condition began in 2004 during basic training.  He reports an uncharacterized discharge due to low back pain (LBP) in 2005 because he was unable to complete training and then enlisted again in March 2007.  LBP recurred in May 2007, again, during basic training.  The CI denied any specific injury or trauma.  Radiographic studies on 17 September 2007 showed mild dextroscoliosis and Grade 1 L5 retrolisthesis.  Magnetic resonance imaging (MRI) on 30 November 2007 showed mild degenerative changes.  The radiologist noted there was narrowing of the neuroforamina (space through which the spinal nerve root passes) with impingement on the L5 spinal nerve roots bilaterally.  There was straightening of the normal lumbar lordosis.  There was no evidence of spondylolisthesis or spondylolysis.  Repeat X-Rays in July 2008 indicated no change.  There was no surgical indication.  

The 1 July 2008 MEB NARSUM examination, 4 months prior to separation, noted complaints of back pain exacerbated by walking, running, bending and lifting (required by his MOS).  Physical examination showed paraspinal tenderness.  Thoracolumbar range of motion (ROM) measurements using a goniometer performed by physical therapy (PT) on 3 June 2008 for the MEB showed, after repetition, flexion of 50 degrees (normal 90) and combined ROM of 160 degrees (normal 240).  The examiner stated the CI had pain with flexion and extension. 

At the 27 August 2008 VA Compensation and Pension (C&P) evaluation, 3 months before separation, the CI reported worse pain in his low back controlled by anti-inflammatory medications and tramadol.  Physical examination showed a normal gait and posture with tenderness to palpation (TTP) and painful motion.  Recorded ROM measurements were 60 degrees of flexion and combined ROM of 210 degrees.  There was no increase in pain, weakness or fatigability after repetition.  

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 limited forward flexion, TTP and reported pain with examination maneuvers not expected to elicit pain based on the known pathology.  The VA rated the piriformis syndrome (low back pain) condition 20% coded 5237 (lumbosacral strain), based on the VA C&P examination 3 months before separation, citing forward flexion of the thoracolumbar spine of 60 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) reported on the all examinations proximate to separation, as well as spasm causing abnormal contour reported on multiple radiographic studies.  There were no examinations that reported a flexion of 30 degrees or less to support the next higher 40% rating.  There was no documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes which would provide for a higher rating under that formula.  

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 condition, coded 5237.  

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

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140711, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170012159, 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