RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00057
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050410

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve O2, Student Aviation Officer, medically separated for “chronic subjective low back pain” with a disability rating of 20%.  

CI CONTENTION:  Condition has progressively worsened and VA increased 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 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 - 20041229	VARD - 20050802	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Subjective Low Back Pain	5299-5237	20%	Degenerative Disc Disease	5243	40%	20050510	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Subjective Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back pain began after sustaining an injury during intramural football in the spring of 2003.  He re-injured his back in March 2004 when he sneezed.  An MRI in April 2004 revealed a disc bulge at L4-5 impressing on the thecal sac but not the nerves, an annular tear, and another disc bulge at L5-S1.  At the 22 July 2004 physical therapy clinic, 9 months before separation, the CI reported pain mainly in the morning upon waking.  The therapist recorded active range of motion (ROM) with trunk was “full”.  Despite conservative treatment and epidural steroid injections, the CI continued to have pain and physical limitation.  There was no surgical indication.  
The 19 August 2004 primary care MEB examination, 8 months prior to separation, noted complaints of chronic daily back pain increased after sneezing.  Pain was increased with running more than a mile or doing sit-ups for an extended period.  Physical examination showed on forward flexion he was able to touch his toes; pain began at 20 degrees and continued throughout the full range.  Pain with extension began at 10 degrees without noting the full magnitude of extension.  Rotation was to 30 degrees, presumably bilaterally (normal).  There was tenderness of the lower lumbar paraspinous muscles and moderately severe spasm with guarding.  The 4 September 2004 physical therapy evaluation, 7 months prior to separation, recorded full ROM of the trunk.  

At the 7 October 2004 MEB NARSUM evaluation, 6 months prior to separation, the CI reported daily back pain that increased with strenuous activities.  He was not taking medication for his back.  Examination of the back was not performed at that visit.  During the 28 October 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported chronic low back pain with some numbness to the lower extremities with running over a mile.  Physical examination recorded forward flexion to 20 degrees (normal 90), extension to 50 degrees (normal 30) and combined ROM of 170 degrees (normal 240).  The examiner’s assessment was history of degenerative disc disease with decrease in flexion and extension.  At the 14 December 2004 ROM evaluation for the MEB by the NARSUM writer, 4 months prior to separation, forward flexion was to 55 degrees (normal 90), lateral flexion was to 25 degrees left and 20 degrees right (normal 30), and rotation was to 20 degrees each side (normal 30).  

At the 10 May 2005 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported low back pain precipitated by sneezing.  The CI reported he had a period of 3 days incapacitation from back pain that began the day of separation.  He stated he avoided lifting more than 50 pounds, was unable to run for the previous year, and avoided many sports.  He also reported occasional radiation of back pain to his right leg.  When driving, he had to stop after 2 hours and readjust.  Physical examination found a normal gait, forward flexion to 30 degrees (normal 90), and combined ROM of 165 degrees (normal 240), most movements with pain.  There was spasm in the lumbar region and the CI sat in a chair with a left leaning posture.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 20%, coded 5299-5237 (analogous to lumbosacral strain), citing forward flexion to 55 degrees.  The VA rated the low back condition 40%, coded 5243 (intervertebral disc syndrome), based on the C&P examination, citing forward flexion of the thoracolumbar spine 30 degrees or less.  

The panel considered the probative value of the seemingly disparate examinations.  The MEB examiner stated both flexion and extension were decreased.  Panel members noted the recorded ROM measurements showed extension was not decreased, but was nearly double the normal extension along with a marked decrease in flexion suggesting the likelihood that the flexion and extension figures were reversed.  In order not to speculate as to the examiner’s true intent, the panel did not consider the MEB examination ROM in the deliberation.  The panel placed high probative value on the totality of the pre-separation evidence, with the greatest weight on the ROM examination requested by the PEB and performed 14 December 2004, just 15 days prior to convening the PEB.  The C&P exam, although proximate to separation, was not consistent with the pre-separation examinations, and likely reflected post-separation worsening.  The panel agreed a 20% rating, but no higher, was justified for limitation of flexion to greater than 30 degrees but not greater than 60 degrees, as reported on the MEB NARSUM examination.  There was no evidence of intervertebral disc syndrome which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under that alternate VASRD formula in the 12 months prior to separation.  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).”  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 low back condition.  

BOARD FINDINGS:  In the matter of the chronic subjective 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 20161213, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180007153, 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