RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02359
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090527

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Wheeled Vehicle Mechanic, medically separated for “chronic low back pain” with a disability rating of 20%.

CI CONTENTION:  “Lumbar back fusions, chronic pain, pain pump implanted, spinal cord stimulator implant.  I have lumbar disk fusions at L5-S1, chronic low back pain, a spinal cord stimulator, and a pain pump implanted (morphine pump).”  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 - 20090325	VARD - 20110813	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5241	20%	Degenerative Changes, Lumbar Spine	5242	0%	STR	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.   According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent back surgery with a three-level lumbosacral fusion in September 2007 for chronic L4-L5 and L5-S1 disc disease.  The CI did not have improvement after the operation, was re-evaluated, and had a spinal cord stimulator implanted on 23 July 2008.  Following surgery and implant procedure, further treatment including long-term chronic narcotic medication therapy did not result in adequate improvement.  

During the 8 October 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 8 months prior to separation, physical examination showed an antalgic gait and guarding.  There was no tenderness or other palpable abnormalities.  The CI reported pain with examination maneuvers not expected to elicit pain based on the known pathology.  Range of motion (ROM) testing recorded active flexion to 40 degrees (normal 90) and combined ROM of 150 degrees (normal 240) after repetition.  

The 19 November 2008 MEB NARSUM examination, 6 months prior to separation, noted complaints of bilateral tingling in the CI’s legs with intermittent numbness in the bilateral posterior legs.  The pain was sharp and localized to his lower back, but radiated to his hips.  The CI reported flare ups of his back pain on a daily basis which lasted all day.  Lifting, bending over, standing and walking exacerbated the condition.  Pain was rated at 5-6/10 at baseline and was exacerbated to 8/10.  Physical examination showed an antalgic gait.  There was tenderness to palpation over the lumbar spinous processes and bilateral sacroiliac joints.  The CI reported pain with examination maneuvers not expected to elicit pain based on the known pathology.  ROM with goniometer recorded active flexion to 40 degrees (normal 90) and combined ROM of 150 degrees (normal 240) after repetition with painful motion.  The examiner noted that the ROMs from the examination were consistent with the MEB examination on 8 October 2008.  

There was no VA examination in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 20%, coded 5241 (spinal fusion), citing limitation of motion.  The VA rated the low back condition 0% coded 5242 (degenerative arthritis of the spine), based on the STR and VA treatment records.  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 MEB and NARSUM examinations.  There was 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 unfitting peripheral nerve impairment which could provide for additional rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the low back pain condition.  

BOARD FINDINGS:  In the matter of the chronic low back pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  

The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150914, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170012615, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.

Sincerely,					      
						      					
Enclosure