RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02243
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070516

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Automated Logistical Specialist, medically separated for “chronic radiating low back pain” with a disability rating of 0%.

CI CONTENTION:  Experiences problems from multiple conditions.  The 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 - 20070406	VARD - 20070607	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Radiating Low Back Pain	5299-5237	0%	L5-S1 Central Annular Tear w/Mild Disc Protrusion and Facet Arthropathy and Neural Foraminal Stenosis w/Degenerative Changes of the Lumbar Spine	5243	10%	20070517	
Chronic Multi-joint Pain	Not Unfitting
	Degenerative changes, Left Knee	5010-5260	10%	20070517	
		Degenerative changes, Right  Knee	5010-5260	10%	20070517	
Pes Planus		Bilateral Pes Planus	5276	0%	20070517	
Insomnia		Insomnia	9499-9440	NSC		
GERD		Acid Reflux	7399-7346	0%	20070517	
Allergic Rhinitis		Allergic Rhinitis	6522	0%	20070517	
Hypertension		Essential Hypertension	7101	0%	20070517	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Radiating Low Back Pain.  According to the service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back pain (LBP) began in 2002 during basic training and progressively worsened during a deployment to Iraq in August 2002.  Lumbar spine X-rays in March 2006 were normal.  Orthopedic evaluation in July 2006 noted non-radiating LBP.  The examination showed a normal gait and no tenderness or spasm of the lumbar spine.  Pain with lumbar flexion was noted.  Lower extremity strength, sensation, and reflexes were normal and straight leg raise testing to elicit radicular symptoms was negative.  Magnetic resonance imaging on 24 July 2006 showed lower lumbar degenerative disc disease (DDD) with lateral recess and neuroforaminal stenosis on the left.  The CI declined spinal injections.  

The 5 March 2007 MEB NARSUM examination, 2 months prior to separation, noted complaints of LBP that radiated bilaterally to the thighs and increased with physical activity.  The CI had reasonably declined operative intervention.  Physical examination showed a normal gait and no muscle spasm present.  There was normal strength, sensation, and reflexes of the lower extremities bilaterally.  Physical therapy measured thoracolumbar (TL) range of motion (ROM) for the MEB on 25 February 2007.  All ROM was repeated three times and TL flexion was to 70 degrees (normal 90) with a combined ROM of 185 degrees (normal 240).  

At the 17 May 2007 VA Compensation and Pension (C&P) evaluation, 1 day after separation, the CI reported lumbar DDD.  Physical examination showed a slow but normal gait, without use of any assistive devices.  There was no muscle spasm or abnormal curvature of the spine.  There was full TL ROM (repeated three times) with painful motion noted.  There was no radiating pain with motion and SLR testing was negative bilaterally.  Lumbar spine X-rays showed “minor” degenerative changes of the lumbar spine.  The VA assessment was lumbar spine DDD and degenerative joint disease without radiculopathy.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 0%, coded 5299-5237 (analogous to lumbosacral strain), citing pain limited motion without spasm or radiculopathy.  The VA rated the low back condition 10%, coded 5243 (intervertebral disc syndrome), based on the C&P evaluation 1 day after separation, citing TL ROM.  The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) and combined ROM (greater than 120 degrees but not greater than 235 degrees) reported on the MEB NARSUM examination and painful motion noted at the C&P evaluation.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  The panel considered whether a higher rating (§4.7) was achieved by using the alternate rating formula based on incapacitating episodes due to intervertebral disc syndrome (IVDS).  Although the CI had intervertebral disc disease there were no incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD 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 low back condition, coded 5243.  

Contended PEB Conditions:  Chronic multi-joint pain, pes planus, insomnia, GERD, allergic rhinitis, and hypertension.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the chronic radiating low back pain condition, the panel unanimously recommends a disability rating of 10%, coded 5243 IAW VASRD §4.71a.  In the matter of the contended chronic multi-joint pain, pes planus, insomnia, GERD, allergic rhinitis, and hypertension conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  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 Radiating Low Back Pain	5243	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150705, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170015111, 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