RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01243
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20041014

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Administrative Specialist, medically separated for “chronic subjective low back pain [LBP], without significant neurologic abnormality” with a disability rating of 10%.  

CI CONTENTION:  “Review 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 (VA), 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 - 20041014	VARD - 20050108	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Subjective LBP …	5299-5237	10%	Degenerative Disease of the Thoracolumbar Spine	5243	40%	20031215	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Chronic Subjective LBP.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in July 2000 after heavy lifting.  Radiographic studies showed a ruptured disc at L5-S1.  Neurosurgery did not recommend surgery at that time.  Her condition worsened in 2003.  Magnetic resonance imaging, dated 11 February 2003, showed L5-S1 disc protrusion and annular tear.  

At the 15 December 2003 VA Compensation and Pension (C&P) evaluation, 10 months before separation, the CI reported daily back pain that “rarely” went down her left leg.  The pain was elicited by physical activity and sleeping.  Flare-ups caused difficulty sitting or standing greater than 20 minutes, lifting greater than 10 pounds, going up stairs or bending backwards.  She denied incapacitation, but reported she missed 15 days of work due to her back condition.  Physical examination showed normal gait and posture.  Straight leg raise testing (for radicular symptoms) was negative bilaterally and there were no signs of intervertebral disc syndrome.  There was no radiating pain on movement.  Muscle spasm and tenderness were present in the lower lumbar area.  Range of motion (ROM) testing showed flexion of 25 degrees (normal 90) that was limited due to pain and combined thoracolumbar ROM of 175 degrees (normal 240) with pain noted during rotation movements.  ROM was not additionally limited by fatigue, weakness, lack of endurance or incoordination.  There was no ankylosis of the spine and X-rays showed a normal lumbar spine.  

During the 8 March 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, the CI reported chronic back pain.  Physical examination showed decreased ROM of the lumbar spine, but no measurements were provided.  Straight leg raise testing was positive bilaterally at 30 degrees.  Neurologic evaluation was normal.  Electrodiagnostic studies on 12 March 2004 showed “evidence consistent with a mild left S1 lumbar radiculopathy.”  

The 2 June 2004 MEB NARSUM examination, 4 months prior to separation, noted complaints of constant daily back pain that radiated down the left buttock to the knee.  The CI also complained of intermittent numbness and “decreased touch sensation” in this area as well.  Physical examination showed normal gait and reflexes.  There was tenderness to palpation of the lumbar spine and sacroiliac joint.  The presence of spasm was equivocal; at one point in the exam it reflected “no muscle spasms at this time” and later in the examination it reflected “decreased ROM of the lower back due to muscle spasm and pain.”  The CI could flex her lumbar spine to “about 45 degrees,” but there were no other ROM measurements provided.  The examiner also noted decreased sensation to light touch of the left leg.  Motor strength was not addressed, but straight leg raise testing was positive on the left at 60 degrees.  The 2 June 2004 physical therapy (PT) MEB ROM study showed a flexion measurement of 50 degrees, with pain, and a combined thoracolumbar ROM measurement of 200 degrees.  The examiner noted active ROM was assessed with an inclinometer.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5299-5237 (analogous to lumbar strain), citing tenderness, thoracolumbar ROM limited by pain and no significant neurological abnormality (likely application of AR 635-40, B-29).  The VA rated the back condition 40%, coded 5243 (intervertebral disc syndrome), based on the C&P examination 10 months before separation, citing forward flexion of the thoracolumbar spine of 30 degrees or less.  

The panel adjudged the PT and MEB examinations had the highest probative value for rating at separation as they were closest to separation.  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 MEB and PT examinations.  

The panel next considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  Radiographic and electrodiagnostic studies supported some level of radicular nerve irritation or involvement, but physical examinations proximate to separation revealed no objective findings of radiculopathy that would impact duty performance.  While the CI may have suffered additional pain from the nerve involvement, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  Therefore the critical decision is whether or not there was a significant motor weakness which would impact military occupation-specific activities.  There was no evidence in this case that motor weakness existed to any degree that could be described as functionally impairing.  The panel therefore concluded that an additional disability 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 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 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 Subjective LBP	5243	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161003, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170018958, 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