RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01379
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041204

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve O4, Logistics Officer, medically separated for “chronic non-surgical low back pain” with a disability rating of 0%. 

CI CONTENTION:  “I have been diagnosed with fibromyalgia, irritable bowel syndrome, PTSD and osteoarthritis by civilian doctors.”  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.   

RATING COMPARISON:  

SERVICE PEB - 20040927	VARD - 20050127	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Non-Surgical Low Back Pain	5243	0%	Degenerative Bulging Disk L4-5 and L5-S1	5010-5237	10%	20040812	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Non-Surgical Low Back Pain (LBP).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s LBP condition began in July 2003 while deployed.  Magnetic resonance imaging revealed degenerative disc disease (DDD), specifically a “disc bulging,” at the lumbosacral junction.  Despite conservative therapy, to include focused steroid injections, the LBP remained.  At the 2 June 2004 MEB NARSUM examination, 6 months prior to separation, the CI endorsed daily, dull and achy LBP aggravated by sit-ups, crunches, running, bending and long walking, and relieved by lying down.  He was unable to ruck or wear a flak jacket or Kevlar due to irritation to his back.  The physical examination (PE) was normal noting \full back range of motion (ROM).  

At the 12 August 2004 VA Compensation and Pension (C&P) evaluation, 4 months before separation, the CI endorsed constant daily LBP with pain and numbness down the backside of both legs and into the soles of both feet.  The pain was relieved by getting off his feet and resting in a reclined position.  The PE revealed a steady gait with no tenderness, swelling or local spasms. Spinal ROM was painful with forward flexion to 60 degrees (normal 90) and a combined ROM of 155 degrees (normal 240).  There were no range changes with repetitive ROM testing.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP condition 0%, coded 5243 (intervertebral disk syndrome), citing ROM limitations due to pain alone.  The VA rated the low back condition at 10%, dual coded 5010-5237 (arthritis, due to trauma-lumbosacral strain).  Members first considered the vast difference in the back ROM values reported by the VA examiner (4 months prior to separation) which were significantly worse than those reported by the MEB examiner just 2 months earlier.  There was no record of recurrent or interim injury or other development in explanation of the more marked impairment reflected by the VA measurements.  While ROM limitations may have progressed over time, there is no evidence in the record from which to conclude that the severity near separation approached that portrayed by the VA.  The panel agreed that the MEB examination was more consistent with outpatient notes and more reflective of the anticipated severity based on the clinical pathology and mechanism of the initial injury.  Therefore, the panel relied more heavily on the MEB ROM measurements; and, accordingly, a normal PE in the absence of painful motion did not meet criteria for a positive impairment rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB’s adjudication for the chronic non-surgical low back pain condition

BOARD FINDINGS:  In the matter of the chronic non-surgical low back pain condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161004, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180005834, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.

Sincerely,					      
Enclosure