RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01583
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040502

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E6, Motor Transport Operator, medically separated for “chronic low back pain secondary to degenerative disc disease” with a disability rating of 10%.

CI CONTENTION:  Current condition supports a higher rating.  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 - 20040304	VARD - 20040819	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain…	5237	10%	L5-S1 Intervertebral Disc Herniation	5237	40%	20040803	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

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 LBP condition began in July 1995 after moving furniture, and he was intermittently seen for multiple back strains throughout 2002 and 2003.  A CT scan on 14 May 2003 revealed an L5-S1 disc herniation without neural defects.  

The 24 November 2003 MEB addendum examination, 5 months prior to separation, noted complaints of LBP with any prolonged activity or inactivity, as well as cold weather and impact activities.  Physical examination revealed an antalgic gait and lumbar tenderness but no muscle spasm and no comments on guarding.  The examiner documented forward flexion as being “somewhat limited approximately hands to mid shin level” with “good lateral bending and rotation;” painful motion was not addressed.  Lower extremity muscle strength was normal with decreased sensation in the “S-1 distribution to the right leg, but intact to light touch.”  

The 7 January 2004 MEB NARSUM examination, 4 months prior to separation, noted CI complaints of LBP.  Physical examination showed no contour deformities or muscle spasms, but decreased left lower extremity sensation from the outer thigh to foot.  Repetitive goniometric ROM measurements taken by physical therapy the same day were: an extremely varying forward flexion recorded as 80, 38, and 23 degrees (normal 90), extension to 20 degrees (normal 30), decreased right and left lateral flexion to 20 and 25 degrees (normal 30), and right and left rotation to 30 degrees (normal).  Combined ROM varied from 205 to 150 degrees (normal 240) due to the significant drop in forward flexion.  

At the 3 August 2004 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported LBP that extended into the right leg.  He was employed at a computer company and “sitting most of the time” with no heavy lifting required.  Physical examination revealed a slow forward gait, lumbosacral tenderness, and paravertebral muscle spasms.  Bilateral lower extremity motor strength and reflexes were normal, and ROM was flexion to 15 degrees with a combined ROM of 115 degrees.  Painful motion was not addressed, but the examiner noted the CI showed discomfort when moving from a seated to standing position. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP condition at 10%, coded 5237 (lumbosacral strain), citing painful motion.  The VA rated the L5-S1 intervertebral disc herniation  condition 40%, also coded 5237, based on the C&P examination 3 months after separation, citing limitation of motion. The panel deliberated over the varying ROM measurements documented by the three examinations proximate to separation.  Regarding the VA examination, members noted that the CI’s claim of mostly sitting at work, coupled with his ability to stay in a sitting position during the examination, was inconsistent with the recorded 15 degrees of forward flexion.  Additionally, members found the severe and rapid decrease in flexion from a near-normal 90 degrees to 25 degrees at the MEB PT evaluation to be questionable in light of a non-neurologic disc herniation of L5-S1.  Thus, the panel agreed the MEB addendum examination, 5 months before separation, held the greatest probative value for rating. The ROM, described as “hands to mid shin level” approximates a forward flexion of 60-80 degrees, which justifies a 10% rating.  While the CI may have experienced radiating pain from the back condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  There was no objective evidence of a radiculopathy with functional impairment (such as weakness) that directly impacted fitness for duty.  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 concluded there was insufficient cause to recommend a change in the PEB’s adjudication for the chronic LBP condition.  

BOARD FINDINGS:  In the matter of the chronic low back pain condition and IAW VASRD §4.71a, the panel unanimously 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 20161023, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20180001872, 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