RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01018
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060514

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Food Service Operations, medically separated for “chronic low back pain” with a disability rating of 10%.  

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 - 20060404	VARD - 20061129	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5239	10%	Degenerative Disc Disease L5-S1 with S1 Radiculopathy	5242	10%	20060713 	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%  	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP).  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s LBP began in April 2005 after lifting boxes and twisting his back.  The CI reported LBP with intermittent numbness of the left lower extremity to the calf.  A lumbar spine MRI on 14 September 2005 showed mild degenerative disc disease (DDD) at L5 and S1 with small focal central disc extrusion at this level, without neuroforaminal narrowing.  Electrodiagnostic studies on 9 November 2005 showed evidence of right S1 radiculopathy.  A civilian orthopedic evaluation on 5 December 2005 noted DDD and an annular tear at L5-S1.  Physical examination showed a normal gait.  There was decreased flexion and extension of the low back.  Strength and sensation of the bilateral lower extremities was normal.  Reflexes were symmetric and straight leg raise testing (SLR) to elicit nerve tension signs was negative.  The CI was able to heel and toe walk without difficulty.  The CI was referred to pain medicine and underwent epidural steroid injections which were not helpful.  

The 10 February 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints of LBP causing inability to run or ruck at all.  Physical examination showed tenderness of the lumbar spine, and thoracolumbar range of motion (ROM) was flexion of 70 degrees (normal 90), but combined ROM was not available due to an incomplete ROM examination.  Lower extremity strength and sensation were intact and SLR was positive bilaterally.  At the 23 March 2006 physical therapy visit, ROM measured after three repetitions was flexion 40 degrees and combined ROM of 230 degrees, limited by pain.  

At the 13 July 2006 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported constant sharp pain in his low back with occasional radiation along the lateral aspect of the right leg to the foot.  He denied numbness/tingling, weakness or bowel/bladder problems.  The CI was not receiving treatment for his back and denied flare-ups.  Physical examination showed a normal gait and spinal contour.  Thoracolumbar ROM measurements showed flexion of 80 degrees (normal 90) and combined ROM of 215 degrees (normal 240) after repetition, limited by pain.  There was no tenderness, spasm or weakness noted.  There was no radiation of pain to the right lower extremity and strength, sensation, and reflexes were normal.  There had been no episodes of incapacitation prescribed by a physician.  Lumbar spine X-rays were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5239 (spondylolisthesis or segmental instability), citing combined passive ranges of motion equal to 330 degrees, and tenderness.  The VA also rated the low back condition 10%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination 2 months after separation, citing flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees.  

The panel noted that the MEB NARSUM and VA examinations supported a 10% rating but the physical therapy ROM evaluation, which occurred between them, showed much reduced ROM, which supported a 20% rating.  The panel reviewed the evidence to explain the discrepancy.  However, there was no change in the CI’s back condition between these serial examinations.  The PT evaluation may have reflected a “bad” day for the CI with increased pain.  However, such limitation of motion was not supported by any other evidence in record.  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) and/or combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the NARSUM and VA examinations.  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 evidence of intervertebral disc syndrome which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula for that condition.  Although the PEB used 5239 for rating there was no evidence in record of spondylolisthesis or spinal instability.  The panel would recommend coding as either 5243 for degenerative disc disease or 5242 for spinal arthritis.  However, there is no benefit to the CI to recommend a code change without an increase in rating and therefore no change to the PEB’s code is recommended.  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 LBP condition.  

BOARD FINDINGS:  In the matter of the low back condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  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 20170311, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180005502, 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