RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00952
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070510

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

CI CONTENTION:  In addition to receiving higher disability ratings from the VA, he requested review of  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 - 20070223	VARD - 20070730	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP	5237	10%	Lumbar Spine DDD with Chronic Pain Syndrome	5243	20%	20070608	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Chronic LBP.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back condition began in December 2003 while moving wall lockers during basic training.  Conservative treatment did not relieve the LBP.  A back MRI showed multi-level degenerative disc disease (DDD).  There was no surgical indication.  

During the 16 January 2007 MEB NARSUM examination, 4 months prior to separation, the CI reported LBP.  Physical examination showed no gait abnormalities or spinal muscle spasm.  Back range of motion (ROM) was not addressed.  The MEB physical therapy (PT) examination 10 days later demonstrated repetitive, goniometric-measured, thoracolumbar flexion to 65 degrees (normal 90) and combined ROM of 170 degrees (normal 240) with painful motion.  

At the 8 June 2007 Compensation & Pension (C&P) examination, one month after separation, the CI reported LBP radiating to the left lower lumbar region.  Physical examination revealed a non-antalgic gait and no tenderness or obvious spine curvature deformity.  Goniometric-measured, thoracolumbar flexion was 70 degrees and combined ROM was 215 degrees with painful motion.  Flexion was reduced to 60 degrees due to pain following repetitive use.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5237 (lumbosacral strain), citing limited flexion.  The VA rated the low back condition 20%, coded 5243 (intervertebral disc syndrome (IVDS)), based on the C&P examination, citing limitation of flexion with repetitive motion.  

The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees), as reported on the VA ROM examination most proximate to separation; this was corroborated by the MEB PT ROM examination at the cusp of a 20% rating.  There was no evidence of IVDS 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 20% for the low back condition, coded 5237.  

BOARD FINDINGS:  In the matter of the low back condition and IAW VASRD §4.71a, the panel recommends a disability rating of 20%, 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	20%	

AR20190007531, 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.