RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01008
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20041012

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

CI CONTENTION:  “Degenerative disc disease, bulging disc and curvature of spine lumbar.”  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 - 20040802	VARD -  NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain…	5299-5242	10%	No VA Exam in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Back Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back pain (LBP) condition began in May 2002 without any specific injury or trauma.  The CI was evaluated for chronic low back pain on 1 August 2002 and was treated with a nonsteroidal anti-inflammatory drug (NSAID), a muscle relaxer, and a profile and was referred for physical therapy.  Radiographic studies in August 2002 showed a moderate rotatory dextroscoliosis (curvature of the spine to the right) and a questionable density in the inferior body of L5 with no other abnormalities seen.  Computerized tomography (CT) of the lumbar spine on 8 October 2002 showed no evidence of mass lesion or significant degenerative changes and no soft tissue abnormality.  Rotoscoliosis (curvature of the vertebral column due to the column turning on its axis) was apparent.  The CI was able to complete a 6-month deployment in early 2003 without incident, although she checked back pain (chronic) on her Post-Deployment Health Assessment.  However, her LBP worsened in October 2003 at which time she was treated with Toradol (ketorolac, an NSAID) intramuscularly.  Magnetic resonance imaging (MRI) of the lumbar spine on 15 March 2004, 7 months prior to separation, ordered for persistent pain with frequent radiation to the left lower extremity, showed a decrease in the height and signal of the disk material between L4/L5 and L5/S1 and a broad based disk protrusion posteriorly and slightly to the right at the L4/L5 disk level, which  caused some narrowing of the right neural foramen (space through which the spinal nerve root passes), but the nerve root appeared intact.  The 20 April 2004 MEB NARSUM examination, 6 months prior to separation, noted complaints of constant LBP that was present on awakening and was aggravated by walking or prolonged standing more than 10-15 minutes.  Treatment with NSAIDs and muscle relaxers provided not much relief, but Percocet (oxycodone, a narcotic, and acetaminophen, a pain reliever) did provide some relief.  Physical examination showed tenderness to palpation along the lumbar spine and a normal gait. The CI had a normal heel and toe walk and a normal squat and recover.  The examiner was silent regarding muscle spasm and guarding.  Thoracolumbar range of motion (ROM) goniometric measurements were flexion to 54 degrees (normal 90) and a combined ROM of 140 degrees (normal 240) and all motions were associated with painful motion.  Straight leg raise (SLR) (to determine nerve root irritation) testing was negative for radiating symptoms.  The examiner’s diagnosis was chronic low back pain with degenerative disc disease, a herniated nucleus pulposus at L4-L5, and rotoscoliosis.  There was no VA examination in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP condition 10%, analogously coded as 5242 (degenerative arthritis of the spine), citing no neurologic abnormality, thoracolumbar ROM limited by pain, and localized tenderness.  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 NARSUM examination.  There was no documentation of intervertebral disc syndrome (IVDS) 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 LBP condition, coded 5299-5242.  

BOARD FINDINGS:  In the matter of the LBP condition, the panel unanimously recommends a disability rating of 20%, coded 5299-5242 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 due to Degenerative Disc Disease	5299-5242	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160927, w/atchs
Exhibit B.  Service Treatment Record

AR20170015827, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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