RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2017-00836
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20061225

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

CI CONTENTION:  Review of all conditions requested.  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 - 20060919	VARD - 20070816	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	0%	Lumbar Spine Disc Disease L4-5	5237	10%	20070315	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI developed low back pain with a strain injury in August 2005.  MRI demonstrated minimal disc disease (“mild” bulging at L4/5 without herniation or neural involvement).  Neurological examinations were normal and surgery was not recommended.  There were provider entries in the STR indicating some non-specific limited range of motion (ROM), but most documented grossly normal ROM with some specifying painful motion.  There was STR documentation of a normal gait and no indication of an abnormal spinal contour.  

The 29 June 2006 MEB NARSUM examination, 6 months prior to separation, documented nonspecific low back pain which limited running to a quarter mile and was aggravated by load-bearing, standing, bending, and lifting.  The physical examination recorded normal neurological findings and gait without note of abnormal spinal contour; there was tenderness and ROM was “full” with pain on extension.  

The 15 March 2007 VA Compensation and Pension (C&P) examination, 3 months after separation, documented nonspecific pain “intermittent with remissions” that interfered with lifting, carrying, and stamina, although it was noted that the CI was employed full-time as an oil field hand.  The physical examination recorded a normal gait and neurological findings without abnormal spinal contour and no guarding, spasm, or tenderness.  ROM was normal in all planes (flexion 90 degrees and combined 240 degrees), specifying painful motion but no ROM degradation with repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back pain 0%, coded 5237 (lumbosacral strain), acknowledging the presence of tenderness and citing no loss of motion.  The VA also rated the low back pain 10%, coded 5237, based on the C&P examination and citing painful motion.  Although there was insufficient limitation of motion to support a 10% rating, the panel agreed a 10% rating was justified for the presence of painful motion and tenderness.  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 the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the low back pain under code 5237.  

BOARD FINDINGS:  In the matter of the low back pain, the panel recommends a disability rating of 10%, coded 5237, IAW VASRD §4.71a.  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 the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Low Back Pain	5237	10%	

AR20190008877, 

Dear XXXXXXXXXXXXX

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.