RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00520
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20081203

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Wheeled Vehicle Mechanic, medically separated for “chronic low back pain” with a disability rating of 20%.

CI CONTENTION:  “Review all conditions.”  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 - 20080819	VARD - 20090526	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5237	20%	Lumbar Spine Degenerative Disc Disease	5242	20%	20090514	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s LBP condition began in 2005 during basic training.  The CI did not seek treatment until he arrived at his first duty station in early 2006.  Radiographic imaging (X-ray) showed mild L4-L5 and L5-S1 disk space narrowing.  An MRI showed a very small L4-L5 disc protrusion.  The CI was treated by physical therapy and pain management without relief.  Surgery was not indicated.

The 30 October 2007 primary care examination revealed spinal tenderness.  There were no muscle spasms, and straight leg raise testing for radiculopathy was positive.  Spinal range of motion (ROM) was “decreased”.  The 21 November 2007 orthopedic evaluation revealed a non-antalgic gait.  The CI was able to heel and toe walk with good balance.  Sensory testing was intact.  Flexion and extension elicited pain which radiated to the buttocks.  The 5 March 2008 MEB NARSUM examination, 9 months prior to separation, noted complaints of chronic, sharp, stabbing lumbar spine pain which radiated to the thighs.  Physical examination showed flexion to 30 degrees (normal 90) and combined ROM was 160 degrees (normal 240); painful motion was present.

At the 14 May 2009 VA Compensation and Pension (C&P) evaluation, 5 months after separation, the CI reported having problems with activities of daily living.  He continued to have lumbar spine pain which radiated into both lower extremities.  He reported flare-ups with any strenuous activity.  Physical examination showed a normal gait and posture.  There was no spinal muscle spasm, weakness, or tenderness.  Straight leg raising testing was negative, and sensitivity and motor strength testing were normal.  Flexion was 60 degrees and combined ROM was 195 degrees; painful motion was present.  There was no loss of ROM, fatigue, weakness, or lack of endurance with repetition.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP condition 20%, analogously coded 5299-5237 (lumbosacral strain), citing limitation of flexion.  The VA also rated the LBP condition 20%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing limitation of flexion.  The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees) as recorded by the VA examination most proximate to separation.  There was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that 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 LBP condition.

BOARD FINDINGS:  In the matter of the chronic LBP 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 20170215, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180004695, 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