RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00562
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070222

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

CI CONTENTION:  “Back, knees, right hip, left ankle.”  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 - 20070104	VARD - 20070521	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5237	10%	Degenerative Disc Disease, Lumbar Spine with Radiculopathy	5243	20%	20070521	
COMBINED RATING:  10%	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 reported a 4-year history of LBP which began following a vehicle rollover accident in Iraq in 2003.  Following the accident, the CI developed intermittent chronic LBP.  In May 2006, the back pain became constant.  AN MRI in July 2006 showed a mild to moderate disk protrusion/herniation of L5-S1, accentuated on the left side, with associated degenerative disc disease.  Despite physical therapy, visits to different pain clinics, and several courses of epidural steroid injections, the CI continued to have pain with activity limitations.  

At the 18 December 2006 MEB NARSUM examination, 2 months prior to separation, the CI reported pain improvement with light duty.  Pain was rated 5/10 at rest but increased to 8/10 with walking, bending, or lifting objects greater than 20 pounds.  Physical examination showed gait, stance, balance, and heel-toe walking were all normal.  Back range of motion (ROM) was limited by pain with flexion of 45 degrees (normal 90) and combined 130 degrees (normal 240).  Tenderness was noted.  

At the 12 March 2007 VA Compensation and Pension (C&P) evaluation, 1 month after separation, the CI reported numbness and tingling aggravated by prolonged sitting, bending over, or picking up objects greater than 50 lbs.  Physical examination showed an antalgic gait with limp favoring the right leg.  Posture and spine contour were normal, with tenderness at L5-S1.  ROM showed flexion of 60 degrees and combined ROM less than 220 degrees and greater than 115 degrees (no rotations recorded).  There were normal reflexes and no lower extremity sensory deficits.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic LBP condition 10%, coded 5299-5237 (analogous to lumbosacral strain), citing pain-limited motion and rated for tenderness, with likely application of the US Army Physical Disability Agency pain policy and/or AR 635-40, B29.  The VA rated the chronic LBP condition 20%, coded 5243 (intervertebral disc syndrome), based on the C&P examination, citing forward flexion limited to 60 degrees.  

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 reported on the NARSUM and VA examinations.  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 recommends a disability rating of 20% for the chronic low back condition, coded 5299-5237.  

BOARD FINDINGS:  In the matter of the chronic LBP condition, the panel recommends a disability rating of 20%, coded 5299-5237 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends that the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Low Back Pain	5299-5237	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170216, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180004708, XXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs. 

Sincerely,					      
Enclosure