RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00859
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20040217

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

CI CONTENTION:  “My back has gotten worse to the point I have had 2 major surgeries.  They have found more than 15+ discs in my back that have the same diagnosis that the Army told me.”  The CI’s 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 at the time of separation.  The panel has neither the role nor the authority to compensate for progression or complications of service-connected conditions after separation.  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 - 20031119	VARD - 20040517	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Degenerative Disc Disease of the Lumbar Spine	5243	10%	20040202	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI reported low back pain while deployed 2002 without any specific injury or trauma.  Magnetic resonance imaging (MRI) on 23 July 2003, ordered for persistent low back pain with radiation down both lower extremities and weakness in the left lower extremity, showed a mild disc protrusion suggested at L5-S1 at the level of the left L5 nerve root.  

At the time of a civilian spine specialist appointment on 27 August 2003, 6 months prior to separation, the CI reported low back pain, described as stabbing pain, which radiated down his legs into his knees.  Physical examination showed no evidence of scoliosis (curvature of the spine), asymmetry, or atrophy.  There was no tenderness of the thoracic or lumbar spine.  Flexion of the lumbar spine was fingertips to the floor, which is normal (90 degrees).  Extension was approximately 15 degrees (normal 30) with pain at the extremes of flexion and extension.  The CI had a normal reciprocating gait with normal motor strength and sensation.  Straight leg raising (to determine nerve root irritation) was negative bilaterally.  Radiographic (X-ray) studies showed degenerative changes throughout the lumbar spine with facet arthritis at L4-S1.  Review of the MRI showed multilevel degeneration most notably at L2-3, L3-4, and L4-5 with disc bulging accompanying all of those levels without any definitive nerve root impingement.  Conservative treatment options were recommended since the CI was young and had multilevel disease, the spine specialist did not believe he could “predictably offer him a satisfactory result with a fusion from L2-S1.”  Additionally, the spine specialist “could find no definitive single-level nerve root compression which is responsible for his lower extremity symptoms.”  Despite conservative treatment, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty.  

The 28 October 2003 MEB NARSUM, 4 months prior to separation, noted complaints of constant low back pain aggravated by sitting more than 15 minutes, standing more than 20 minutes, or walking at his own pace and distance more than 1½ miles.  Physical examination showed tenderness to pressure at the lumbosacral junction bilaterally without palpable spasm or any visible deformity.  ROM measurements performed on 23 October 2003 showed a flexion of 65 degrees and a combined ROM of 170 degrees (normal 240); however, the NARSUM examiner noted forward flexion and right lateral flexion measurements could not be validated.  There was decreased sensation from the outer calf to the inner foot bilaterally, left greater than the right, consistent from L5 nerve root sensory dysfunction.  Motor strength was normal and straight leg raising test was negative.

At the 2 February 2004 VA Compensation and Pension (C&P) evaluation, performed 15 days before separation, the examiner referenced the MEB examination for the back condition.  Physical examination showed that the CI had a normal posture and gait and no evidence of any lumbar altered curves.   The thoracic spine was clinically within normal limits and examination of the lumbar spine referred to the MEB examination.  The straight leg raise test was negative, and the CI had normal strength, normal reflexes, and normal sensation of both lower extremities.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5237 (lumbosacral strain), citing no radiculopathy, no spasm, no spinal deformity or altered gait.  The VA also rated the back condition 10% coded 5243 (intervertebral disc syndrome), based on the STR, citing limitation of forward flexion.  

The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) and combined ROM greater than 120 degrees but not greater than 235 degrees reported by the spine specialist and MEB NARSUM examinations proximate to separation.  There was no muscle spasm or guarding 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 evidence of intervertebral disc syndrome (IVDS) which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula (for IVDS).  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 were 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 20160920, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170017101  , 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