RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00648
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20061211

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Human Resources Information System Management Specialist, medically separated for “chronic back pain” with a disability rating of 0%.  

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 - 20061024	VARD - 20070807	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5243	0%	Degenerative Disc Disease, L5-S1	5242	10%	20070606	
Hyperthyroidism	Not Unfitting	Graves’ Disease	7900	NSC	20070606	
Pregnancy	Not Unfitting	No VA Placement	
Myopia	Not Unfitting	Myopic Astigmatism	6009	NSC	20070606	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in November 2002 while pitching a tent during a training exercise.  In July 2005, an MRI study revealed a herniated disc at L5-S1.  In February 2006, the CI underwent an epidural steroid injection and nerve root block (reported as a percutaneous discectomy).  In May 2006, the CI was seen by neurosurgery for possible surgical intervention, but she became pregnant so surgery was deferred.  In July 2006 electrodiagnostic studies of the lower extremities showed no evidence of lumbar radiculopathy.  
At the 3 August 2006 MEB NARSUM examination, 4 months prior to separation, the CI was pregnant and on a modified bed rest profile to spare her back as much as possible.  Physical examination showed range of motion (ROM) of flexion to 80 degrees (normal 90) and combined ROM of 185 degrees (normal 240).  The 27 September 2006 MEB NARSUM addendum, 3 months prior to separation, detailed the extremity, spine and neurologic examinations.  It documented accentuated thoracolumbar lordosis with no scoliosis, gross deformities, tenderness or muscle spasm noted.  ROM showed flexion of 75 degrees with combined ROM of 215 degrees.  Motor strength and reflexes were normal.  Gait, heel-walk and toe-walk were normal.  

At the 6 June 2007 VA Compensation and Pension (C&P) evaluation, 6 months after separation, the CI reported daily sharp back pain.  Precipitating factors included prolonged sitting and resting.  Physical examination showed steady gait.  ROM showed flexion of 90 degrees and combined ROM of 215 degrees with painful motion.  There was no ankyloses noted.  Motor, sensory and reflex examinations were normal except for an absent left Achilles deep tendon reflex.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 0%, coded 5243 (intervertebral disc syndrome), citing thoracolumbar ROM limited by pain.  The VA rated the back condition 10%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing lumbar spine measured at 185 degrees (combined) and objective evidence of painful motion.  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 as reported on the NARSUM examinations proximate to separation.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  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 10% for the chronic back pain condition, coded 5243.  

Contended PEB Conditions:  Hyperthyroidism, Pregnancy and Myopia.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  Pregnancy is not a disability.  None of the conditions were profiled or implicated in the commander’s statement.  All conditions were judged to be medically acceptable and meet retention standards.  There was no performance-based evidence from the record that any of the conditions 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 any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the back condition, the panel recommends a disability rating of 10%, coded 5243 IAW VASRD §4.71a.  In the matter of the contended hyperthyroidism, pregnancy and myopia conditions, the panel recommends no change from the PEB determinations as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  

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

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Back Pain	5243	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170217, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180004726, 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