RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00610
BRANCH OF SERVICE: ARMY 	SEPARATION DATE:  20040519

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

CI CONTENTION:  The CI’s conditions continue to worsen.  The 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 - 20040315	VARD - 20040821	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain, with L4-5 Herniated Nucleus Pulposus, without Significant Neurologic or Electrodiagnostic  Abnormality	5243	10%	Back Pain with Disk Herniation, Lumbar Spine with Paresthesia of Left Big Toe	5243	20%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Back Pain.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI injured his low back during a physical fitness test in October 2002.  There was no surgical indication.  During the 12 January 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported constant low back pain (LBP) that was elevated on exertion with “tingling” in the left leg for the past 6 months.  Physical examination showed a positive straight leg test with left leg pain and weakness.  The 2 March 2004 MEB NARSUM (examination completed 4 January 2004, 5 months prior to separation) noted complaints of constant LBP that worsened to include left leg tingling due to exertion while deployed to Iraq.  The CI reported the LBP was exacerbated by bending, lifting, prolonged standing or sitting and that the pain interfered with sleep.  Physical examination showed a positive straight leg raise on the left with reported pain and noted weakness.  Axial loading test was negative with deep tendon reflexes of 2+ bilaterally at the patellar and 1+ bilaterally at the ankles noted.  Decreased strength in the left hip flexors and decreased sensation in the left big toe; decreased strength with dorsiflexion of the extensor hallucis longus was also noted.  Range of motion (ROM) testing recorded: 42 degrees forward flexion (normal 90), 20 degrees extension (normal 30), 24 degrees right and 15 degrees left lateral bending (each normally 30) and 18 degrees right and 12 degrees left rotations (each normally 30) with a combined ROM of 130 degrees.  An EMG nerve conduction study on 10 Feb 2004 was grossly normal.  The CI did not present for the scheduled VA Compensation and Pension evaluation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic back pain 10%, coded 5243 (intervertebral disc syndrome [IVDS]), citing limited forward flexion.  The VA rated the chronic back pain 20%, coded 5243 (IVDS), based on the STR 3 months after separation, citing limited forward flexion.  

The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees) as reported on the NARSUM examinations.  There was no documentation of IVDS with incapacitating episodes which would provide for a higher rating under that formula, or evidence of peripheral nerve impairment which would provide for additional rating.  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 chronic back pain, coded 5243.  

BOARD FINDINGS:  In the matter of the chronic back pain condition, the panel unanimously recommends a disability rating of 20%, coded 5243 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 Back Pain	5243	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160830, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170016858, 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