RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00927
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040208

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

CI CONTENTION:  The CI contended his degenerative spine disease condition.  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 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 - 20031203	VARD - 20051129	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5299-5237	10%	Degenerative Changes Lumbar Spine	5242	10%	20050823	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:  

Chronic Back Pain.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in May 2001 after a parachute jump.  X-ray studies showed a fracture of the L5 vertebrae and an MRI showed degeneration at the L4 level.  There was no surgical indication.  At the 18 December 2002 orthopedic clinic appointment, 14 months prior to separation, the CI reported persistent lower back and upper leg pain posteriorly, rated 0-8/10.  Physical examination was unremarkable; no spasm, full range of motion (ROM), and no tenderness.  Neurologic examination was normal, no weakness, numbness, or tingling.  A neurological examination on 19 February 2003, 12 months prior to separation, was normal, with intact reflexes, no weakness, and a negative straight leg raise test for radiculopathy.  There was pain in his left thigh.  

During the 8 August 2003 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported recurrent back pain that prevented him from standing on his feet for long periods of time.  Physical examination showed tenderness, no spasms, normal strength, and normal reflexes.  A straight leg raise test was negative for radiculopathy.  ROM measurements performed by physical therapy (PT) on the same day showed flexion of 115 degrees (normal 90) and a combined ROM of 235 degrees (normal 240).  The CI reported low back pain rated 6/10.  At the 3 October 2003 PT clinic appointment, 4 months prior to separation, ROM measurements showed flexion of 50 degrees and combined ROM of 185 degrees.  At the 6 November 2003 MEB NARSUM, 3 months prior to separation, the CI reported low back pain in the mornings and increased pain with running or marching of any kind.  The examiner reported the results of the MEB examination that was recorded on 8 August 2003 and the results of the PT ROM measurements from 8 August and 3 October 2003.  

At the 23 August 2005 VA Compensation and Pension (C&P) evaluation, 19 months after separation, the CI reported constant, very severe pain associated with flare-ups that happened at least once a week and lasted for 2 days.  He stated that the pain “radiates to both of his hips, knees, and ankles, with associated weakness of his legs.”  The CI denied any periods of incapacitation in the prior 12 months.  Physical examination showed no muscle spasm and mild tenderness.  ROM measurements showed a normal flexion of 95 degrees and a normal combined ROM of 240 degrees, with painful motion only during rotation.  During repetitive flexion, there were no signs of fatigability or changes.  The examiner estimated that during flare-ups there could be a 10% reduction of lateral flexion.  The CI had a normal gait, and the lower extremities had normal reflexes and normal strength.  He was able to walk on his heels and toes with no difficulty.  The examiner noted that X-ray studies on 23 August 2005 showed spina bifida occult S1, unfused apophysis at L5, and slight disc degenerative changes at L4, L5, and S1.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5237 (lumbosacral strain), citing tenderness and L4 degeneration.  The VA rated the back condition 10%, coded 5242 (intervertebral disc syndrome), citing functional disability because of pain, with consideration given regarding the impact of pain and acute flare-ups on the functional disability of joints.  

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 3 October 2003 PT examination proximate to separation.  There was no forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine, thus the next higher 40% rating was not justified on this basis.  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 condition, coded 5242.  

BOARD FINDINGS:  In the matter of the chronic back pain condition, the panel unanimously recommends a disability rating of 20%, coded 5242, IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends that 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	5242	20%	

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 

AR20180001942, 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