RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00568
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20051115

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

CI CONTENTION:  An additional condition was not considered.  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 - 20051007	VARD - 20051208	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5243	20%	Post Laminectomy Syndrome, Status Post L5-S1 Laminectomy/Discectomy…	5243	10%	20050901	
			Left Leg Radiculopathy Associated with Post Laminectomy Syndrome…	8599-8520	10%	20050901	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Chronic Low Back Pain (LBP).  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent a lumbar laminectomy and discectomy in June 2004 for a herniated disc.  Radiographic imaging (MRI) showed narrowing L5-S1 disc space with disc and left S1 exiting nerve scars.  At the 9 May 2005 physical therapy appointment, the CI reported occasional-radiating left thigh pain above the knee.  Range of motion (ROM) measurement was flexion to 85 degrees (normal 90); combined ROM and painful motion were not addressed.  X-rays showed moderate L5-S1 intervertebral disk space narrowing and L5-S1 degenerative disk disease.  The 1 August 2005 MEB NARSUM examination, 3 months prior to separation, noted complaints of moderate, constant pain in his lower mid lumbar spine which radiated to the left sacroiliac area and left leg, requiring the use of analgesics, narcotics, and muscle relaxers for relief.  Physical examination showed spinal tenderness with muscle spasm.  Gait and spinal contour were not addressed.  Thoracolumbar ROM was flexion to 50 degrees and combined ROM was 170 degrees (normal 240), with painful motion.  An EMG and nerve conduction study on 3 August 2005 showed a normal left lower extremity with no radiculopathy or neuropathy.

At the 1 September 2005 VA Compensation and Pension (C&P) evaluation, 2 months before separation, the CI reported LBP that radiated down the left buttock and lower extremity.  He denied periods of incapacitation.  Physical examination showed a normal posture and an abnormal gait attributed to lower left extremity weakness.  There was spinal tenderness and muscle spasm.  Left lower extremity motor function showed slight 4/5 lower weakness.  Sensory function was within normal limits.  Repetitive-thoracolumbar ROM was flexion to 80 degrees and combined ROM of 190 degrees, without painful motion.  The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP condition 20%, coded 5243 (intervertebral disk syndrome), citing pain and spasm with flexion of 50 degrees.  The VA rated the LBP condition 10%, coded 5243 (intervertebral disk syndrome), based on the C&P examination, citing rating criteria under the General Formula for Diseases and Injuries of the Spine.

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 MEB NARSUM examination and adjudicated by the PEB.  There were no incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under that alternate VASRD formula.  The panel also noted there was no objective evidence of a radiculopathy with functional impairments (such as weakness) that interfered with the satisfactory completion of the CI’s military duties.  The panel therefore concluded that 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 adjudication for the chronic 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 20170214, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180004710, 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