RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01162
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20041019

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

CI CONTENTION:  “I’m not sure the ringing in my ears was considered, or the degenerative discs.”  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 - 20040825	VARD - 20050406	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5243	10%	Left L5-S1 Disc Herniation	5243	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP).  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in January 2003 after moving equipment and falling out of an office chair resulted in severe LBP. Radiographic studies (X-rays) on 21 March 2003 were negative.  Treatment included Flexeril and Motrin.  Despite nonsteroidal pain medication, physical therapy, and reduced activity level, the CI continued to have back pain and developed sciatica on the right side which were aggravated by heavy lifting, ruck marching, running, sit-ups, and sitting for extended periods of time.  On 7 November 2003, MRI of the lumbar spine showed a slight bulging of the L1-L2 disc and a left paracentral disc herniation at L5-S1, effacing epidural fat that did not indent the thecal sac.  The remainder of the study was negative.  
At the 26 January 2004 neurosurgical examination, 9 months prior to separation, the CI reported back pain and sciatica.  Physical examination showed the CI “favors the right leg but no severe limp.”  Lumbar spine spasm and tenderness were present.  Range of motion (ROM) showed extension to 10 degrees (normal 30) and flexion to 15 degrees (normal 90) with some pain in the center and right side of his back.  Gait was fairly normal with some increased pain (antalgic).  The neurosurgeon opined that the symptoms and findings were consistent with right lumbar radiculopathy, but the symptoms and findings were opposite.  The more significant abnormality of central disc herniation was to the left at L5-S1.  The CI was determined not to be a surgical candidate. Though offered a second opinion he chose to continue with conservative treatment.  

The 16 July 2004 physical therapy (PT) MEB ROM evaluation documented forward flexion of 60 degrees that decreased to 50 degrees on repetition, and combined ROM of 170 degrees (normal 240) with no decrease on repetition.  The 8 July 2004 MEB NARSUM examination, 3 months prior to separation, noted complaints of LBP with sciatica.  Physical examination showed extreme pain with forward flexion at 70 degrees, as well as pain with alternate leg raising.  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%, coded 5243 (intervertebral disc syndrome), citing pain with flexion, with likely application of AR 635-40, B-29.  The VA also rated the LBP condition 10%, coded 5243, based on the STR, citing incapacitating episodes having a total duration of one week but less than 2 weeks during the past 12 months.  

The panel adjudged the MEB PT ROM evaluation had the highest probative value for rating at separation, as it offered the only complete ROM evaluation in evidence.  The neurosurgical examination showed spasm, tenderness, and more severely limited back flexion; however, it had decreased probative value due to its remoteness from separation.  The panel agreed 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 MEB PT examination.  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 back condition, coded 5243.  

BOARD FINDINGS:  In the matter of the back condition, the panel unanimously recommends a disability rating of 20%, coded 5243, 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	5243	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 

AR20180000475, 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