RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00045
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20080303

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Health Care Specialist, medically separated for “chronic low back pain” with a disability rating of 10%.  

CI CONTENTION:  Back, hip and right leg pain have worsened. 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 - 20090317	VARD - 20080910	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5243	10%	Herniated Nucleus Pulposus of Lumbar Spine	5243	10%	20080229	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in April 2006 after lifting boxes.  X-rays in May 2006 showed degenerative disc disease with bulging disc at L4-5 and neuroforaminal (space through which the spinal nerve root passes) narrowing with mild effect on the left L5 spinal nerve root.  Non-surgical treatment was recommended.  

During the 13 March 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 12 months prior to separation, the CI reported a herniated disc and back pain.  Physical examination showed a normal gait, mild lumbar tenderness to percussion, no bowel or bladder dysfunction, negative straight leg raise test, and normal lower extremity motor strength and sensation.  He had minimal pain with range of motion (ROM) testing for flexion and rotation, and mild pain with extension, but measurements were not provided.  At the 5 June 2007 physical medicine examination, 10 months prior to separation, the CI had a normal gait and paraspinal muscle tenderness.  At the 2 August 2007 MEB NARSUM, 7 months before separation, the CI complained of back pain rated at 5-6/10 mostly on the right side, and without radiating pain, tingling or numbness.  The examiner reiterated findings from the 13 March 2007 MEB examination.  The 11 September 2007 physical therapy (PT) ROM study for the MEB, 6 months prior to separation, showed thoracolumbar flexion of 75 degrees (normal 90),  and a combined ROM of 200 degrees (normal 240), after repetition and with pain.  

At the 29 February 2008 VA Compensation and Pension (C&P) evaluation, 4 days before separation, the CI reported lumbar pain with radiation into the lower extremities, and provoked by stooping, bending, lifting and vigorous physical training.  The examiner noted the CI missed work due to his back pain, but without quantification or qualification.  Physical examination showed normal gait, reflexes, strength, and sensation with negative straight leg raise testing.  There was no spasm, tenderness, or postural abnormalities.  After repetition, forward flexion was 80 degrees, and combined thoracolumbar ROM was 215 degrees.  There was pain with all ROM movements, but no fatigue, weakness, or lack of endurance.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5243 (intervertebral disc syndrome), citing tenderness and limitation of motion.  The VA also rated the back condition 10%, coded 5243, based on the C&P evaluation 4 days before separation, citing limited, painful motion.  The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion greater than 60 degrees but not greater than 85 degrees and/or combined ROM greater than 120 degrees but not greater than 235 degrees, as reported on the MEB PT and VA evaluations.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no evidence of intervertebral disc syndrome which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration under that alternate VASRD formula.  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 adjudication for the back condition.  

BOARD FINDINGS:  In the matter of the back 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 20161205, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180003345, 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