RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02480
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050928

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty O3, Ordnance Officer, medically separated for “longstanding low back pain” with a disability rating of 0%.  

CI CONTENTION:  The CI attached a four page letter for consideration.  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 - 20050520	VARD - 20060705 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5237	0%	Degenerative Disc Disease Lumbosacral Spine	5242	10%	20060419	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  60%  	

ANALYSIS SUMMARY:  

Low Back Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back condition began in 1993 after power lifting.  X-rays showed some narrowing of the lumbosacral facets, otherwise they were normal.  Evaluation in September 2002 noted the CI had some evidence of mild disc desiccation and received a steroid injection in 1999 and a sacroiliac joint injections in 2000.  Examination in September 2002 revealed the CI was very tender just lateral to the posterior superior iliac spin of the pelvis on the right, but had normal flexion and extension.  Chronic bursitis over the right posterior superior iliac spine was treated with a steroid injection and salsalate, a nonsteroidal anti-inflammatory drug was prescribed.  The CI underwent physical therapy again in October 2003 after having failed conservative treatment in the past including TENS (transcutaneous electrical nerve stimulation), traction, ice and heat.    Magnetic resonance imaging on 24 October 2003 shows central disc protrusion causing subtle impression upon the ventral aspect of the thecal sac and producing mild bilateral lateral recess stenosis at L5-S1 and neural foramina (where nerve pass through the vertebral column) appeared bilaterally patent.  A note dated 3 August 2004 indicated the CI was seen by neurosurgeons twice for low back pain, who concluded the condition was non-operatable degenerative joint disease.   

The 7 December 2004 MEB NARSUM examination, 10 months prior to separation, noted complaints of chronic pain, but also multiple flares of her low back pain over the years, which began after a lifting injury.  Physical examination showed the CI had no spinous tenderness, no swelling or deformity, and normal strength, sensation, and reflexes.  Tests for radicular signs were negative.  Lumbar range of motion (ROM) measurements performed by a physical therapist using an inclinometer on 7 December 2004 revealed a flexion of 30 degrees calculated based on subtracting the measurement at L5-S1 (reflecting pelvic movement) of 65 degrees from the measurement of T12-L1 (reflecting both lumbar and pelvic movement) of 95 degrees.  Using the same formula, extension was 15 degrees.  Left lateral flexion was 25 degrees and right lateral flexion was 20 degrees.  During the 19 August 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 1 month prior to separation, the CI reported “lower back pain at every station I have ever been to.”  The examiner checked the normal box for clinical evaluation of the spine, but listed degenerative disc disease in low back in the summary of defects and diagnoses.

At the 19 April 2006 VA Compensation and Pension evaluation, performed 6 months after separation, the CI reported nagging dull pain that was occasionally sharp, with infrequent radiation to the right buttock, but no radiation into either lower extremity.  The examiner found no scoliosis, but there was marked accentuation of the lumbar lordosis and mild tenderness on palpation over the right sacroiliac joint area and the midline in the lumbar spine area.  The CI had a forward flexion of 90 degrees (normal 90), extension 15 degrees (normal 20) and a combined ROM of 225 degrees (normal 240) with no decreased movement after repetition, but function was limited by pain in the right lower lumbar and sacroiliac areas.  The CI had a normal gait, and normal strength, sensation, and reflexes.  Straight leg raising (to determine nerve root irritation) was negative.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the longstanding low back pain condition 0%, coded 5237 (lumbar spine strain), citing no radiculopathy, spasm or tenderness on examination; and although painful, there was a full range of spinal motion.  The VA rated the back condition 10% coded 5242 (degenerative arthritis of the spine), based on the VA C&P examination 6 months after separation, citing limited and painful motion of the lumbosacral spine.  

The panel noted that the MEB NARSUM examination provided ROM values for the lumbar spine motion performed using an inclinometer and calculations based on AMA guidelines rather than the goniometric thoracolumbar ROMs specified by the VASRD (§4.71a, Plate V).  Panel members agreed that the VA examination, performed about 6 months after separation, was more detailed and compliant with VASRD rating guidelines as well as more proximate to separation than the MEB NARSUM examination.  Furthermore, there seemed to be a mismatch between the physical therapy calculations and the PEB’s noting a full range of spinal motion.  Therefore the panel placed greater probative value on the VA examination.  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) or combined ROM greater than 120 degrees but not greater than 235 degrees reported on the VA, examination proximate to separation.  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 documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes which would provide for a higher rating under that 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 5242.  

PANEL FINDINGS:  In the matter of the low back condition, the panel unanimously recommends a disability rating of 10%, coded 5242 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	
Degenerative Disc Disease Lumbosacral Spine	5242	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20151023, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170013250, 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