RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00756
BRANCH OF SERVICE:  army	SEPARATION DATE:  20041105

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Indirect Fire Infantryman, medically separated for “chronic low back pain…” 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 - 20040618	VARD - 20041109	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain without Neurologic Abnormality	5299-5237	10%	Residuals, Low Back Injury, with Herniated Disc, L4-L5	5237	20%	20041109	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in October 2003 while conducting physical training in Iraq.  During the 3 November 2003 Primary Care Clinic appointment, the CI complained of low back pain that radiated down both legs with numbness.  The examiner referred the CI to orthopedics for consult.  MRI studies on 4 November 2003 showed degenerative changes with disc herniation at the L4-5 level.  

At the 18 February 2004 physical therapy (PT) appointment, the CI complained of constant low back pain and left leg numbness with a pain intensity of 6/10.  Lumbar range of motion (ROM) measurements noted active flexion to 30 degrees (normal 90), extension 15 degrees (normal 30) with additional limitation during repetitive motion.  During the 1 March 2004 PT appointment, ROM measurements showed active flexion to 30 degrees, and extension of 15 degrees, with painful motion and lumbosacral spinal tenderness.  

The 11 March 2004 MEB NARSUM examination, 8 months prior to separation, noted complaints of chronic low back pain with shooting nerve pain down his left leg.  Pain intensity was a 5/10 with constant tingling sensation in his fingers and toes.  Physical examination showed the CI had difficulty raising legs while on his back and had decreased ROM during repetition.  Lumbar ROM measurements showed an active flexion to 30 degrees (normal 90), and extension of 5 degrees (normal 30), with painful motion and lumbosacral spinal tenderness.  Straight Leg Raise testing re-produced the CI’s pain bilaterally at 5 degrees.  There was tenderness to palpation with light touch to bilateral lumbar soft tissues.  At the 16 June 2005 PT ROM evaluation (cited by the PEB), 5 months prior to separation, the trunk flexion was 50 degrees and combined ROM was 180 degrees with painful motion.  

At the 9 November 2004 VA Compensation and Pension (C&P) evaluation, 4 days after separation, the CI reported chronic low back pain with a constant dull ache and increased discomfort during prolonged standing, walking, bending and lifting.  Additionally the CI complained of radiating pain from the lower back down both legs to the feet with no previous surgeries.  Physical examination showed a normal posture and gait with well-developed muscle tone.  Thoracolumbar ROM measurements recorded active flexion to 45 degrees (normal 90), and combined ROM of 195 degrees (normal 240), with “discomfort.”  There was no objective evidence of postural abnormalities, painful motion, edema, weakness, tenderness, redness, heat, abnormal movement or guarding of movement.  There was no evidence of any additional limitation by pain, fatigue, weakness or lack of endurance, locking, or instability following repetitive movement.  The diagnosis was degenerative disc disease with herniated disc L4-L5.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5299-5237 (lumbosacral strain), citing combined ROM of 195 degrees [Note:  The panel noted the PEB cited the combined ROM as 195 degrees, but apparently did not truncate the measurements which exceeded the normal standard for rotation IAW VASRD 4.71a Note 2; combined ROM from that examination was 180 degrees].  The VA rated the back condition 20%, coded 5237 (lumbosacral strain), based on the C&P examination 4 days after separation, citing degenerative disc disease with flexion limited to 45 degrees and extension limited 30 degrees.  

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 PT and VA examinations closest to separation.  While the CI may have suffered additional pain from the nerve involvement, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  There was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula.  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 low back pain condition, coded 5299-5237.  

BOARD FINDINGS:  In the matter of the chronic low back pain condition, the panel unanimously recommends a disability rating of 20%, coded 5299-5237 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 Low Back Pain without Neurologic Abnormality	5299-5237	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160926 w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180002268, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

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