RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00620
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040123

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Chemical Operations Specialist, medically separated for “chronic low back pain” with a disability rating of 10%.  

CI CONTENTION:  The CI made no specific contention.  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 - 20031124	VARD - 20040930	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low back Pain	5299-5237	10%	Disc Bulges at L3, L4, and L5	5237	10%	20040830	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic low back pain condition began in February 1998 after receiving an epidural during childbirth.  X-ray taken on 25 July 2003 revealed vertebral bodies of were of normal height, with normal spacing between discs.  There was no evidence change due to trauma, abnormal growth, or significant arthritic change.  There was no evidence of spondylolysis or forward displacement of vertebra.  Despite treatment, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  

A 10 October 2003 MRI, 3 months prior to separation, revealed the CI’s lower spine had normal alignment throughout, no evidence of fracture, misalignment or dislocation.  Mild disc bulges were seen at L3-4 and L4-5, which caused no narrowing of the open canals on either side of the vertebra.  The 15 October 2003 MEB NARSUM examination, 3 months prior to separation, noted complaints of stabbing and piercing pain with an intensity of 6/10 at rest, and numbness and tingling in her left leg from her low back to the back of her foot.  Physical examination showed normal spine curvature, and normal upper and mid-chest spine vertebrae.  The CI’s spine was tender with muscle spasms over L3-4-5 bilaterally, and over the lower spine to pelvis joints on both sides.  The CI’s extension ROM was limited by pain.  Flexion was 90 degrees (90 normal) and extension 29 degrees (30 normal) with a combined ROM of 219 degrees (240 normal).  Testing the integrity of the spinal cord and peripheral nervous system produced normal results, and motor strength was normal.  All nerve paths connecting to the legs were.  There was no sign of a nerve impingement on the right (negative right SLR), while left side low back pain occurred at 85 degrees that did not radiate to the leg.  The CI did not exhibit pain when compression was applied to the spine, and there was no indication of a non-organic component to pain.  

At the 30 August 2004 VA Compensation and Pension (C&P) evaluation, 7 months after separation, the CI complained of lower back pain that traveled into the right leg and up the back.  The CI reported inability to run and could not stand for longer than 15 minutes.  Physical examination showed tenderness to touch at L3, L4, L5, and the muscles on both side of the spine.  There were no complaints of radiating pain on movement, and no sign a herniated disc.  Flexion ROM was 80 degrees, extension 25 degrees and a combined ROM of 225 degrees limited by pain.  It was not additionally limited by fatigue, weakness, lack of endurance and incoordination.  There was no abnormal immobility or fusion of the spine, or signs of deterioration or dysfunction of spinal discs present.  Neurological examination of the lower extremities revealed that motor function and sensory function were within normal limits.  The right land left side lower extremity reflex testing was normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic low back pain condition 10%, analogously coded 5299-5237 (lumbosacral or cervical strain), citing some reduction in spinal ROM due to pain.  The VA rated the chronic low back pain condition 10%, coded 5237 (lumbosacral or cervical strain), based on the C&P examination 7 months after separation, citing pain and limitation of forward flexion.  The panel agreed that a 10% rating, but no higher, was justified for forward flexion of the thoracolumbar spine 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 NARSUM and VA examinations proximate to separation.  Although there was muscle spasm, it was not 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), or evidence of ratable 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 concluded that there was insufficient cause to recommend a change in the PEB adjudication for 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 20160912, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170016312, 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,					      
						      					
Enclosure