RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX 	CASE:  PD-2016-01271
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040827

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Traffic Management Coordinator, medically separated for “chronic low back pain” with a disability rating of 0%.  

CI CONTENTION:  The CI contended for chronic skin disorder.  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 - 20040809	VARD - 20050317	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5237	0%	Degenerative Disc Disease Lumbosacral Spine	5243	20%	20041123	
Neutrophilic Dermatosis	Not Unfitting	Neutrophilic Dermatosis Syndrome	7899-7806	30%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP).  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in September 2003 after falling on her tailbone.  The 7 August 2003 MEB NARSUM examination, 12 months prior to separation, noted complaints of considerable pain with sitting or standing for prolonged periods.  Physical examination showed a normal gait.  There was no evidence of kyphosis, lordosis or scoliosis.  The CI was particularly tender over the left sacroiliac joint, but there was no evidence of paravertebral muscle tenderness or spasm or midline tenderness.  Muscle strength and neurologic evaluation were normal.  A straight leg raise test (SLR) (to determine nerve root irritation) at 60 degrees was negative bilaterally.  A MEB addendum for the back with no clear date confirmed the clinical evidence as above by noting some radicular symptoms in the lower left extremity.  The SLR was also negative with a forward flexion of 90 degrees.  The examiner’s assessment was intervertebral disc degeneration with left lower extremity radiculitis.

Magnetic resonance imaging (MRI) dated 4 December 2003 demonstrated a small disc bulge at L4-L5 and a posterior disc osteophyte complex (arthritic changes) at L5-S1, which was eccentrically placed to the left and caused mild to moderate left-side neural foraminal narrowing.  Disc desiccation was seen at L5-S1.  X-rays of the lumbar spine dated 14 December 2003 demonstrated the lumbar vertebrae were all in good alignment.  A disc osteophyte complex was seen at L5-S1 eccentrically placed to the left causing moderate left-sided neural foraminal narrowing with some disc narrowing at that level.  There was a small disc bulge seen at L4-5 with no evidence of neural foraminal narrowing or central canal stenosis seen.  An MRI of the left hip was normal.  

At an orthopedic clinic evaluation of 7 January 2004 the examiner’s assessment was intervertebral disc degeneration based on an MRI that revealed a degenerative process to the L5-S1 spine.  On 23 January 2004 it was noted that the LBP remained unresolved with rest and nonsteroidal anti-inflammatory drugs (NSAIDs) and the CI had pain with prolonged sitting and standing.  On examination the thoracolumbar spine exhibited an abnormal curvature and tenderness on palpation to the paravertebral muscles and the region of the L1 joint.  There was a full range of motion (ROM) of the thoracolumbar spine.  A Patrick-FABER test (to determine hip or sacroiliac pathology) was positive at the left side of the sacroiliac joint.   There was no tenderness on palpation of the spinous processes and there were no spasms of the right or left paraspinal muscles.  During the 18 February 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported recurrent pain in lower back.  Physical examination showed ROM with discomfort during flexion and extension. 

At an orthopedic clinic examination on 16 April 2004, 4 months prior to separation, the CI reported persistent pain in the lumbosacral area, left greater than right, with some medial thigh and occasional medial leg pain without limb weakness, but with tingling without numbness.  Examination revealed diffuse tenderness of the lumbosacral and sacroiliac areas with left sacroiliac pain with internal and external rotation of the hip.  Options of neurosurgery evaluation, physical therapy, and epidural steroid injections were discussed with the CI, who declined the options.  The 25 June 2004 addendum to the MEB NARSUM physical examination showed a non-antalgic gait.  There was tenderness diffusely involving the lumbosacral area and left and right sacroiliac areas.  Neurologic evaluation was unremarkable and forward flexion was to approximately 90 degrees (normal 90).  

At the 23 November 2004 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported severe pain.  The physical examination showed 75 degrees of flexion and 15 degrees of extension (normal 30) with a combined ROM of 150 degrees (normal 240).  Pain, fatigue, weakness and lack of endurance followed repetition and there was a 25 percent decrease in ROM after repetitive use.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP condition 0%, analogously coded 5299-5237 (lumbosacral strain), citing resolution of pain, normal gait, full ROM and no tenderness or spasm.  The VA rated the back condition 20%, coded 5243 (intervertebral disc syndrome), based on the C&P examination 3 months after separation, citing a 25 percent decrease in the combined ROM “calculated as approximately 112 degrees.”  There was no limitation of thoracolumbar spine motion to support a minimum rating under the General Rating Formula for Diseases and Injuries of the Spine.  However, the MEB examination noted the presence of painful motion marked by discomfort with flexion and extension and at an orthopedic examination diffuse tenderness of the lumbosacral and sacroiliac areas with left sacroiliac pain with internal and external rotation of the hip was noted.  Therefore, a 10% rating was warranted.  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 recommends a disability rating of 10% for the chronic low back condition, coded 5243.  

Contended PEB Condition: Neutrophilic Dermatosis.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  Hospital records related to the neutrophilic dermatosis were not available in evidence before the panel, nor were they obtainable after a repeated request.  Although the missing documents may contain relevant evidence, members agreed that the available MEB NARSUM addendum and VA evidence is sufficiently probative to render a fair assessment of the presence or absence of applicable VASRD rating criteria and functional limitations.  It is the panel’s view that the missing evidence did not materially affect its recommendations.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation, albeit the skin eruption occurred after the NARSUM, MEB examination, profile, and commander’s statement were written or approved.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition; and so, no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the chronic low back condition, the panel unanimously recommends a disability rating of 10%, analogously coded 5243 IAW VASRD §4.71a.  In the matter of the contended neutrophilic dermatosis condition, the panel unanimously recommends no change from the PEB determination as not unfitting.  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 Low Back Pain	5243	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160927, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170019474, 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