RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01075
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20060505

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E5, Motor Transport Operator, medically separated for “chronic back pain” with a disability rating of 10%.

CI CONTENTION:  The CI made no specific contention.  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 - 20060223	VARD - 20061117	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5299-5237	10%	Thoracolumbar Condition	5237	10%	20060731	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:  

Chronic Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s chronic back pain began in February 2003 after getting out of a vehicle on a night mission when she missed a step.  On 9 May 2004 she complained of several episodes of low back pain while working as a trucker.  She experienced numbness and tingling in the left leg.  X-rays of the lumbar spine were normal.  MRI of the lumbar spine dated 2 August 2004 was normal for the CI’s age without evidence of a lateralizing disc herniation or significant acquired spinal stenosis.  

During the 13 January 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported reoccurring back pain, mostly with sitting for long periods of time or when continuously bending over.  The examiner noted negative straight leg raise testing (to determine nerve root irritation) and checked normal for the clinical evaluation of spine, lower extremities, and neurologic components.  The 13 January 2006 MEB NARSUM examination noted complaints of occasional back pain, but no numbness or tingling.  The CI reported that prolonged sitting, especially with driving long distances, aggravated her condition.  Physical examination showed a normal gait and stance.  She could heel and toe walk without difficulty.  There was mild tenderness in the left paraspinal area.  The CI had normal motor strength and reflexes of the lower extremities.  Provocative testing to elicit spinal nerve root irritation was negative.  Repetitive range of motion (ROM) measurements performed by a physical therapist revealed flexion of 70 degrees (normal 90) and combined thoracolumbar ROM was 200 (normal 240).  The rotation measurements were performed with a goniometer, but all other measurements were performed with an inclinometer.  There was pain in all planes except for right rotation.  There were no radiating symptoms, gait abnormalities, or lower extremity weakness.  

At the 31 July 2006 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported chronic 9/10 low back pain with spasms.  The pain occasionally (monthly) traveled to the left lower extremity and was elicited by physical activity or from sitting or standing for long periods.  The CI also reported that she had trouble with bending and lifting.  She denied incapacitation.  Physical examination showed normal gait, posture, and curvatures of the spine.  There was tenderness, but no spasm, ankylosis, nerve root irritation, or radiating pain on movement noted.  There were no signs of intervertebral disc syndrome (IVDS) with chronic and permanent nerve root involvement.  ROM testing showed flexion of 70 degrees and combined thoracolumbar ROM of 160 degrees.  The examiner noted that following repetitive use, the joint function was additionally limited by 5 degrees due to pain, fatigue, and lack of endurance with pain having the major functional impact.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5299-5237 (analogous to lumbosacral strain), citing thoracolumbar ROM limited by pain with localized tenderness.  The VA also rated the back condition 10%, coded 5237, based on the C&P examination, citing “forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined ROM of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees.”

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 physical therapy and VA 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 IVDS 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 concluded there was insufficient cause to recommend a change in the PEB adjudication for the chronic low back condition.  

BOARD FINDINGS:  In the matter of the chronic low back pain condition and IAW VASRD §4.71a, the panel 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 20170223, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180006638, 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