RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00258
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040523

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Attack Helicopter Repair Mechanic, medically separated for “chronic low back pain [LBP] with a history of a lifting injury” with a disability rating of 0%.  

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 - 20040130	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP	5237	0%	No VA Exam in Evidence	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic LBP.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the LBP began in December 2001 after heavy lifting.  Radiographic imaging (X-rays) in August 2002 documented a normal spine with no evidence of bony defects, spondylolysis (degeneration), or spondylolisthesis (slippage).  Further imaging (MRI) in July 2003 documented L5-S1 disc herniation with some narrowing of the exiting nerve canal and multilevel degenerative joint disease (DJD).  At a 15 December 2003 physical therapy (PT) visit, 5 months prior to separation, range of motion (ROM) measurements with a dual inclinometer documented 60 degrees lumbar flexion, with pain during extension and left rotation.  The 24 December 2003 MEB NARSUM examination noted complaints of LBP exacerbated by heavy lifting, bending, stooping, prolonged standing and running.  The CI denied radicular pain, paresthesias, and weakness of the lower extremities.  Physical examination showed normal gait with no evidence of kyphosis, lumbar lordosis or scoliosis, paravertebral muscle tenderness or spasm, or midline tenderness.  There was no VA examination in evidence within the 12-month allowable window for adjudication.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated the LBP 0%, coded 5237 (lumbosacral or cervical strain), citing ROM limited by pain.  The December 2003 PT examination specified lumbar ROM measurements performed using the dual inclinometer method that measures isolated lumbar spine motion, not thoracolumbar ROM used by the VASRD for rating purposes.  Lumbar flexion was recorded as 60 degrees after repetitive motion.  The normal lumbar flexion by the dual inclinometer method is 60 degrees.  

Application of VASRD §4.59 (painful motion) was supported by the physical examination proximate to separation to achieve a minimum rating (10%) under code 5237 (lumbosacral strain).  The panel agreed that a 20% rating was not supported as lumbar flexion was normal and there was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour.  There was no evidence of intervertebral disc syndrome which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under that alternate VASRD formula.  There was no evidence of an associated unfitting radiculopathy for consideration of a separate peripheral nerve rating.  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 LBP, coded 5237.  

BOARD FINDINGS:  In the matter of the low back pain, the panel unanimously recommends a disability rating of 10%, coded 5237 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  The panel recommends 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 LBP	5237	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160427, with attachments
Exhibit B.  Service Treatment Record

AR20170015222, 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