RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX		CASE: PD-2015-02429 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20020528

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

CI CONTENTION: “Please review all conditions.” 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 at the time of separation. The panel has neither the role nor the authority to compensate for progression or complications of service-connected conditions after separation. 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 - 20020311		VARD - 20021004	
Condition	Code	Rating		Condition	Code	Rating	Exam	
Chronic Low Back Pain	5293	10%		Chronic Low Back Pain	5293	20%	STR	
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 suffered an atraumatic onset of back pain approximately July 2000 without any specific injury or trauma. Magnetic resonance imaging (MRI) demonstrated degenerative disc disease (“minimal” herniation at L5/S1 without neural encroachment). There was no pain radiation or subjective weakness, but the CI reported occasional right lower extremity sensory symptoms. Multiple STR entries documented normal neurological findings (5/5 strength), with none to the contrary. Multiple entries documented normal range of motion (ROM), although a few noted modest limitations (flexion reduced by a third, extension by a half per one examiner). There was no STR evidence for any more significant ROM limitation. There were STR entries that documented a normal gait, with none to the contrary; and, there was no documentation of any incapacitating flares of back pain (quarters,

duty excuse, etc.). Surgery or epidural steroid injections were offered and declined, with the CI asserting that he remained able to do his job.

The 15 January 2002 NARSUM examination, 4 months before separation, documented constant pain rated 3-4/10 without radiation or subjective weakness; although, the CI reported intermittent bilateral foot numbness that was increased with activity, to include running and lifting. The physical examination recorded a normal gait, normal neurological findings (5/5 strength, symmetric reflexes, no comment regarding sensation), and some pain with flexion at 60 degrees and with extension at 15 degrees). Full ROM excursions were not clarified (the preceding possibly reflect only the onset of pain). There was no VA rating examination in evidence proximate to separation and the VA rating was based on the STR.

The panel directed attention to its rating recommendation based on the above evidence. The 2002 VASRD coding and rating standards for the spine, which must be applied to the panel’s recommendation IAW DoDI 6040.44, differed significantly from the current VASRD §4.71a general rating formula for the spine. The PEB’s 10% rating under the older code 5293 (intervertebral disc syndrome) did not cite a rationale, although it did note the absence of neurologic abnormality); but, the applicable 5293 criterion was “mild.” VASRD code 5293 offered ratings of 20% for “moderate, recurring attacks” and 40% for “severe; recurring attacks, with intermittent relief.” The highest 60% rating required neurological deficits not in evidence. The VA’s 20% rating under the same code cited the “moderate” criterion without further elaboration.

The only other applicable codes available in the 2002 VASRD were 5292 (lumbar limitation of motion) and 5295 (lumbosacral strain). A 20% rating under code 5292 required “moderate” ROM limitation, and members agreed that the ROM evidence (with a preponderance of STR examiners recording normal ROM and the NARSUM specifying only pain at mid-ranges) did not sufficiently justify a rating higher than 10% under code 5292. A 20% rating under code 5295 required muscle spasm with bending and “loss of lateral spine motion” which were not in evidence; thus, it was not favorable to the PEB rating.

Members deliberated whether a more favorable rating was justified under the above criteria of code 5293. It was noted, however, that the language for both the “moderate” and “severe” ratings specified “recurring attacks.” No such attacks were in evidence, and it would be logical to expect that if there had been any significant frequency of such attacks, the CI would have been unable to do his job and more receptive to surgical intervention or epidural injections. Members thus agreed that the evidence was better aligned with the 10% criterion (“mild” being a fair characterization of the clinical severity) than with the 20% criteria under code 5293. 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 of the chronic 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 20151008, w/attachments Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record

AR20170012907, 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,