RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02420
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060710

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Health Care Specialist, medically separated for “low back pain,” with a disability rating of 10%.

CI CONTENTION:  The CI contends his rating was too low.  The CI’s 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 - 20060426	VARD - 20061228	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Back Pain Without Neurologic Abnormality	5299-5237	10%	Herniated Disc L4-L5	5243	10%	20060907	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:  

Back Pain without Neurologic Abnormality.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back pain began in 2003 while conducting patient lifts during AIT.  Magnetic resonance imaging studies on 28 June 2005 showed left lumbar disk bulge (L4-L5) without significant cord or nerve root compression. There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty. The 3 March 2006 MEB NARSUM examination, 4 months prior to separation, noted complaints of low back pain with occasional radiation into the back of both thighs.  The CI denied numbness and tingling of the inner thighs.  The pain was exacerbated with impact activities, heaving lifting prolonged sitting or wearing body armor.  Physical examination showed a non-antalgic gait and mild diffuse tenderness to palpation of the paraspinal muscles from L1 to S1.  Motor, reflexes and sensory were normal.  Range of motion (ROM) was flexion of 90 degrees (normal) and a combined ROM of 160 degrees (240 normal).   At the 7 September 2006 VA Compensation and Pension (C&P) evaluation, performed 2 months after separation, the CI reported tightness and soreness and spasms in the lumbar area.  The CI rated his pain at 3-7/10.  Physical examination showed a normal gait and no evidence of spasms.  There was lumbar spine and muscle tenderness to palpation bilaterally.  ROM was flexion of 85 degrees with pain and a combined ROM of 195 degrees.  There was no change in motion after repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5299-5237 (analogous to lumbar spine strain), citing combined thoracolumbar ROM of 160 degrees.  The VA also rated the back condition 10% coded 5243 (intervertebral disc syndrome), based on the VA C&P examination 2 months after separation.  

The panel agreed that a 10% rating, but no higher, was justified combined ROM (greater than 120 degrees but not greater than 235 degrees) reported on the NARSUM and VA examinations and for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) reported on the VA examination.  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.  There was no evidence of intervertebral disc syndrome (IVDS) which resulted in 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 concluded that there was insufficient cause to recommend a change in the PEB adjudication for the back condition.  

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

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

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20151003, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170012898 , XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:  

	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,