RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00589
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050523

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

CI CONTENTION:  She requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20050413	VARD - 20050809	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5299-5237	10%	Degenerative Disc Disease, L3-S1	5299-5242	10%	20050713	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in February 2001 after performing a “cable run.”  She was diagnosed with scoliosis with X-rays indicating significant thoracolumbar left convex scoliosis.  Despite the back pain, she was cleared to deploy to Kuwait in October 2003, and returned to full military specialty duties.  In December 2004, an MRI showed degenerative disc disease and a disc protrusion that displaced the L5 nerve root; surgery was not recommended.  Electrodiagnostic studies on 1 February 2005 were unremarkable and without evidence of a right radiculopathy or focal neuropathy.  
During the 31 January 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported chronic low back pain (LBP).  Physical examination revealed curvature of the thoracic and lumbar spine and tenderness of the lumbosacral area.  There was limitation of movement in flexion, extension and lateral bending, but measurements were not included.  Straight leg raise (SLR) testing to elicit radicular symptoms was positive.  At the MEB NARSUM examination on the same day, the CI complained of low back pain associated with heavy lifting and stated she could not lift more than 30 pounds without recurrence of significant pain.  She also had numbness and tingling of the right leg and left foot.  Physical examination showed obvious curvature of the thoracic and lumbar spine as well as tenderness; SLR testing was negative.  Range of motion (ROM) evaluation showed flexion of 90 degrees (normal) and combined ROM of 190 degrees (normal 240), limited by pain.  At a follow-up medical clinic visit on 5 April 2005, 2 months before separation, the CI reported LBP rated at 8/10, with numbness and tingling in the legs.  Physical examination showed a normal gait and full ROM without tenderness.  

At the 13 July 2005 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported a constant dull ache of the lower back, with pain radiating into the right leg and foot, and aggravated by prolonged standing, walking, bending and lifting.  Physical examination showed a normal gait and posture and the ability to heel-toe walk and stand on one foot without pain.  The back appeared to be symmetrical with vertebrae midline and no tenderness present.  The provider noted a mild scoliosis but no loss of normal curvature of the lower back (lordosis).  The ROM study showed “discomfort” at 60 degrees of flexion and combined ROM of 210 degrees.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5299-5237 (lumbosacral strain), citing thoracolumbar ROM limited by pain.  The VA also rated the back condition 10%, analogously coded 5299-5242 (degenerative arthritis of the spine), based on the C&P examination, citing forward flexion of the thoracolumbar spine greater than 60 degrees and not greater than 85 degrees or combined ROM of the thoracolumbar spine of greater than 120 degrees but not greater than 235 degrees.  Members noted that the VASRD 4.71a rating criteria are based on maximum achievable ROM values and not on where pain first occurs, as documented by the VA examiner.  Thus, the panel placed great probative value on the MEB NARSUM ROM study which supported a 10% rating for combined ROM greater than 120 degrees but not greater than 235 degrees.  While the CI had a developmental scoliosis, there was no evidence that muscle spasm was responsible for the abnormal curvature.  Also, 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 back condition.  

Contended PEB Condition:  Plantar Fasciitis.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the chronic back pain and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended plantar fasciitis, the panel recommends no change from the PEB determination as not unfitting.  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 

AR20180011258, 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