RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01118
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070213

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Unit Supply Specialist, medically 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 – 20061214 	VARD - 20070817	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain…	5237	10%	Mechanical Low Back Pain…	5237-5010	10%	20070725	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP).  According to the service treatment record and MEB narrative summary (NARSUM), the CI experienced sharp pain in his lower back and thoracic spine areas after lifting heavy cables while working in the motor pool.  This pain gradually worsened.  Plain films demonstrated a minimal degree of scoliosis.  An MRI showed degenerative disk disease with disk bulging at L5-S1 without encroachment into the spinal canal or neuroforamina.  A bone scan revealed no abnormalities, with particular attention to the spine.  At the time of the physical therapy appointment on 31 August 2006, 5 months prior to separation, the CI reported low back dull aching pain at 5/10, and 7-8/10 with aggravating activity.  On examination there was a normal gait, increased thoracic kyphosis, and paraspinal tenderness.  Active range of motion (ROM) was within normal limits in all planes.  The CI reported pain with examination maneuvers which would not be expected to elicit pain, based on the known pathology.  

During the 28 October 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, physical examination showed LBP with forward flexion.  The 17 November 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints of pain that radiated down the leg into both thighs.  There was diminished feeling in the right thigh and he lost feeling in his feet if he ran, walked a lot, or stood.  Physical examination showed tenderness.  ROM (lumbosacral) flexion was 30 degrees and combined ROM was 160 degrees (normal 240) all limited by pain.  The CI reported pain with examination maneuvers which would not be expected to elicit pain based on the known pathology.  

At the 25 July 2005 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported constant back pain with radiation down his right leg.  Physical examination showed a normal gait and tenderness.  Thoracolumbar ROM measurements showed flexion of 75 degrees (normal 90) and combined ROM of 215 degrees.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5237 (lumbar spine strain), citing tenderness.  The VA also rated the low back condition 10%, coded analogously to 5010 (arthritis, due to trauma, substantiated by X-ray findings), based on the C&P examination, citing painful or limited motion of a major joint or group of minor joints.  The panel noted that the MEB NARSUM examination reported lumbosacral flexion at 30 degrees, which suggested consideration of the 40% rating; however, the examiner specified lumbosacral motion, and not the thoracolumbar spine as required in the VASRD.  The panel therefore concluded the MEB NARSUM examiner was reporting lumbosacral ROM without the inclusion of thoracic motion.  Panel members agreed that the VA examination, performed about the same time relative to separation, was more detailed and compliant with VASRD rating guidelines; therefore the panel placed greater probative value on the VA examination.  

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 combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the VA examination.  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 incapacitating episodes which would provide for a higher rating under the intervertebral disc syndrome 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 LBP condition.  

BOARD FINDINGS:  In the matter of the LBP 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 20170222, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180004775, 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