RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00581
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050624

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Infantryman, medically separated for “chronic subjective low back pain” with a disability rating of 10%.  

CI CONTENTION:  “Condition has only gotten worse over time.”  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 - 20050505	VARD – 20050829 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Subjective Low Back Pain	5243	10%	Lumbar Spondylosis with Herniated Nucleus Pulposus at L3-4, L4-5, and L5-S1	5243	10%	20050503	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:  

Chronic Subjective Low Back Pain (LBP).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s LBP condition began in 1999 when he jumped off a truck with his rucksack and sustained acute back pain with radiation into the left leg.  Magnetic resonance imaging (MRI) on 28 August 2004 showed lumbar spondylosis (degenerative disc disease) with central protrusion at L3-4 and bilateral foraminal narrowing.  Evaluation by neurosurgery on 27 September 2004 concluded there was no surgical indication.  

At the 11 March 2005 family practice appointment, 3 months prior to separation, the CI reported LBP, and on examination, there was no spasm or tenderness.  Pain was elicited by flexion, and the thoracolumbar spine demonstrated full range of motion (ROM).  

The 30 March 2005 MEB NARSUM examination, 3 months before separation, noted complaints of chronic persistent LBP and intermittent left leg pain with stress and increased activity.  Physical examination showed normal alignment with tenderness to palpation.  Thoracolumbar ROM measurements showed flexion to 45 degrees (normal 90) and combined ROM of 135 degrees (normal 240).  

At the 3 May 2005 VA Compensation and Pension (C&P) evaluation, 2 months before separation, the CI reported constant pain that traveled into his left lower extremity.  Physical examination showed normal posture and gait, but there was lumbar paraspinal muscle spasm and tenderness.  Thoracolumbar ROM measurements showed flexion to 70 degrees and a combined ROM of 200 degrees after repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP condition 10%, coded 5243 (intervertebral disc syndrome), citing thoracolumbar ROM limited by pain.  The VA also rated the low back condition 10%, coded 5243, based on the C&P evaluation, citing painful and limited motion of the thoracolumbar spine.  In considering the somewhat conflicting examination findings, members noted that the ROM values reported on the MEB NARSUM were significantly different from other measurements in evidence, and thus placed more probative value on the family practice and C&P examinations with respect to rating.  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 C&P evaluation proximate to separation.  Although there was muscle spasm, it was not severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% 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 LBP condition.  

BOARD FINDINGS:  In the matter of the chronic subjective 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 20170216, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180006527, 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