RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00196
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20030810

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

CI CONTENTION:  “Review all conditions.”  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 - 20030508	VARD - 20030728	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP	5299-5295	0%	Back Strain with L4-5 Facet Hypertrophy	5293-5295	20%	20030716	
			Recurrent Right Lower Extremity Nerve Root Compression Syndrome	5293-8520	10%	20030716	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Low Back Pain (LBP).  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back condition began in September 2001 after performing sit-ups and he felt a pop.  After a complete evaluation he was found to not be a surgical candidate.  The CI was treated with physical therapy, traction, medications and transcutaneous electrical nerve stimulation (TENS) with little to no improvement.  

The 4 April 2002 magnetic resonance imaging (MRI) of the lumbar spine showed a very mild 
L4-5 disc bulge with facet hypertrophy at L3-4, L4-5 and L5-S1 with the L-4-5 hypertrophy causing mild neuroforaminal stenosis.  A 14 April 2002 neurodiagnostic study found no evidence of neuropathy or lumbar radiculopathy.  

The 4 October 2002 MEB NARSUM examination, 10 months prior to separation, noted complaints of chronic LBP with occasional radiation down both legs to the feet.  He complained of pain with opening the hatch of the Bradley fighting vehicle and after walking for prolonged periods of time.  
Physical examination showed forward flexion to 70 degrees, extension to 10 degrees and lateral rotation to 45 degrees.  All movements were performed with painful motion.  There was also tenderness with palpation over the spinous processes from T12 to L4.  

An additional, 26 March 2003 MEB NARSUM examination, 5 months prior to separation, noted complaints of continued LBP with occasional radiation down both legs to the feet.  He had pain with any lifting and was unable to perform any portion of the Army physical fitness test (APFT).  
Physical examination showed forward flexion to 20 degrees and extension to 10 degrees.  There was tenderness to palpation over the spinous processes from L2 to L5.  

At the 16 July 2003 VA Compensation and Pension (C&P) General evaluation, performed less than 1 month before separation, the CI reported LBP with lumbar spine weakness, spasms, fatigability, lack of endurance, stiffness, and right greater than left lower extremity weakness.  Physical examination showed normal posture and gait.  Range of motion (ROM) was recorded as 45 degrees flexion, extension 20 degrees, lateral bending 30 degrees bilaterally and rotation 45 degrees bilaterally.  All motions were stated by the CI to be with pain.  There was diffuse tenderness of the spine and no muscle spasms were noted.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP condition 10%, coded 5299-5295 (analogous to lumbosacral strain), citing the lack of neurologic abnormality or documented chronic paravertebral muscle spasms on repeated examinations, with characteristic pain on motion and the US Army Physical Disability Agency pain policy.  The VA rated the LBP condition 20% dual coded 5293-5295 (intervertebral disc syndrome – lumbosacral strain), based on the C&P examination 1 month before separation, citing pain with slight limitation of flexion and extension with recurrent spasm.  

There was limitation of motion of the lumbar spine that panel members agreed should be characterized as moderate but not severe to justify a 20% rating using code 5292 (spine, limitation of motion of, lumbar).  The panel agreed that it would be possible to grant a 10% rating but no more using code 5295 based on characteristic pain on motion but that it provided no rating advantage to the CI and VASRD §4.7 dictates where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned.  There was no evidence of intervertebral disc syndrome to support a rating using that code (5293).  

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the LBP condition, coded 5292.  

BOARD FINDINGS:  In the matter of the LBP condition, the panel unanimously recommends a disability rating of 20%, coded 5292 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	
Chronic Low Back Pain	5292	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160406, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170014132, 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