RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00949
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050215

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

CI CONTENTION:  Her back continues to worsen and negatively impacts daily activities.  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 - 20041027	VARD - 20050330	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Mechanical Low Back Pain	5299-5237	0%	Myofascial Syndrome with Chronic Strain, Lumbar Spine	5299-5237	10%	20050113	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20% 	

ANALYSIS SUMMARY:  

Mechanical Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back condition began in September 2001 after performing sit-ups on concrete during physical training.  X-rays of the lumbar spine dated 4 September 2003 demonstrated no evidence of fracture, bone defect, spondylolysis (a defect or stress fracture in the pars interarticularis of the vertebral arch), or spondylolisthesis (sliding of one vertebra over another below it).  The intervertebral disc spaces and vertebrae were symmetric and the examination was otherwise within normal limits.  Physical therapy, rest, and nonsteroidal anti-inflammatory medication from September 2003 to March 2004 did not relieve the low back pain.  X-rays of the lumbar spine dated 5 April 2004 were normal and unchanged from a prior study.  Orthopedic evaluation on that date noted abnormal curvature of the thoracolumbar spine with tenderness of the paravertebral muscles.  The range of motion (ROM) was full without any exceptions.  The lumbosacral spine exhibited tenderness of the spinous processes and no spasms of the paraspinal muscles.  Testing for sacroiliac joint pathology was negative bilaterally.  The CI’s gait was normal.  A bone scan dated 26 April 2004 demonstrated normal soft tissue uptake and normal bone activity throughout the spine at all levels.  

The 18 June 2004 MEB NARSUM examination, 8 months prior to separation, noted complaints of chronic low back pain.  Physical examination showed a normal gait.  There was no evidence of abnormal spinal curvatures.  The heel and toe walk were normal without listing to either side.  There was some tenderness of the paravertebral muscles on both sides of the lumbar spine but no evidence of spasm.  During the 28 July 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, the CI reported back pain.  The examiner checked abnormal for the spine on the clinical evaluation and noted a P3 for low back pain, but did not record any findings.  However, low back pain was listed in the significant or disqualifying defects section.  

At an internal medicine appointment on 14 September 2004 the CI complained of radiation of pain down both legs and paresthesias (numbness/tingling to the posterior thigh and buttock) off and on for 4-5 months.  She had no bowel or bladder complaints or genital numbness.  Medications, including Naprosyn (naproxen, a nonsteroidal anti-inflammatory drug) and Flexeril (cyclobenzaprine, a muscle relaxer), provided some relief.  On examination there was tenderness on the spinous processes and marked spasm of the paraspinal muscles with decreased ROM and negative straight leg testing (to determine nerve root irritation).  Deep tendon reflexes were diminished and the examiner was unable to elicit ankles reflexes.   Amitriptyline (for nerve pain) and methocarbamol (a muscle relaxer) were added to the medication protocol.  On 14 October 2004, an orthopedic surgeon indicated the CI had no clinical evidence of radiculopathy.  An MRI was reported to be normal as were a bone scan and lumbar spine films.  No further treatment or evaluation was indicated.  

At the 13 January 2005 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported pain, described as throbbing, burning, sharp, and sometimes squeezing, aching, or sticking, in the mid and lower regions of her back, with radiation to her lower buttocks.  Physical examination showed a normal posture and gait.  There was tenderness of the thoracolumbar spine but no muscle spasm.  ROM measurements of the thoracolumbar spine were flexion 0-80 degrees (normal 0-90) and a combined ROM of 205 degrees (normal 240).  ROM was not limited by pain, fatigue, weakness, lack of endurance, or incoordination with repetition.  There was no ankylosis of the thoracolumbar spine or evidence of any intervertebral disc syndrome or any bowel or bladder dysfunction.  X-rays of the lumbosacral spine dated 14 January 2005 were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 0%, analogously coded 5299-5237 (lumbosacral strain), citing the CI did not meet minimal rating criteria for pain.  The VA rated the low back condition 10%, also coded 5299-5237, based on the C&P examination, citing painful motion and a limitation of motion as a result of pain.  

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 VA examination 1 month prior to separation, and the presence of localized tenderness noted on the NARSUM examination.   There was no muscle spasm or guarding proximate to separation 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 mechanical low back condition, coded 5299-5237.  

BOARD FINDINGS:  In the matter of the mechanical low back condition, the panel recommends a disability rating of 10%, coded 5299-5237 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	
Mechanical Low Back Pain	5299-5237	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170228, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record  

AR20180008595, 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