RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  pd-2016-00797
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20040126

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3,  Cannon Crewmember, medically separated for “chronic low back pain” with a disability rating of 10%.  

CI CONTENTION:  “Review of 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 - 20031217	VARD - 20040210	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5237	10%	Degenerative Disk Disease, Lumbar Spine	5242	40%	20031216	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50% 	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to service treatment record  and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back condition began in February 2003 with no specific injury or trauma.  Upon deployment in March 2003, his back pain increased from lifting heavy rounds and prolonged standing, and he was redeployed when he could not perform in his military specialty.  March 2003 X-rays were normal, but September 2003 magnetic resonance imaging (MRI) showed mild degenerative disk disease at L5-S1 and a minimal central disk bulge without significant encroachment upon the spinal canal or neuroforamina.  Conservative treatment along with two steroid injections provided no significant lasting relief.  At a 1 October 2003 orthopedic visit, the CI reported having some pain relief with traction and denied radiculopathy.  The examiner documented tenderness over the L5-S1 region, no sensory deficits and deep tendon reflexes at 2+ bilaterally.  During a 3 November 2003 neurosurgery visit, MRI results were interpreted as “early DJD of L5-S1 but no neural compromise seen.” The examiner noted “no deficits,” further stating “I have nothing to offer – surgery will not help him.”   

The 21 November 2003 MEB NARSUM examination 2 months prior to separation, documented CI complaints of unacceptable levels of low back pain when lifting heavy rounds and riding in a tracked vehicle.  Physical examination recorded range of motion (ROM) with forward flexion to 75 degrees (normal 90) with pain, extension to “greater than 10” (normal 30), and side bending and lateral rotation “greater than 30 degrees (normal 30).”  Motor and sensory examinations were normal with tenderness at L4, L5 and S1 centrally and on the right paraspinous muscles.  

At the 16 December 2003 VA Compensation and Pension (C&P) evaluation, 1 month before separation, the CI reported constant, aching low back pain rated at 8/10.  Physical examination showed no radiating pain on movement, muscle spasm or tenderness.  Forward flexion was to 24 degrees with a combined ROM of 130 degrees (normal 240).  All ROM was limited by pain with repetition but was not further limited by fatigue, weakness, lack of endurance or incoordination.  Gross spine examination was normal with no signs of ankylosis or intervertebral disc syndrome.  

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 (lumbar spine strain), citing forward flexion limited to 75 degrees.  The VA rated the low back condition 40%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination approximately 1 month before separation, citing limitation of forward flexion.  Members noted the great disparity between the VA and NARSUM examinations and found no evidence in the record explaining the sharp decline in the CI’s forward flexion in such a short period of time.  Radiographs demonstrated only mild degenerative changes at L5-S1 and no other significant findings.  The CI had normal posture and gait with no spasms and a combined ROM of 130 degrees during the C&P evaluation.   Panel members agreed that a rating higher than 10% was not justified.  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 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 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 20160913, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170017985, XXXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX

	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