RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01179
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20080827

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Human Resources Specialist, medically separated for “lower 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 - 20080513	VARD - 20081008	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lower Back Pain…	5299-5242	10%	Lumbar Disc Disease…	5243-5237	20%	20080930	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Lower Back Pain (LBP).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s LBP began in June 2006 with no specific associated injury or trauma.  Radiographic studies showed intervertebral disc degeneration with a herniated disc at L5-S1.  Evaluation by neurosurgery concluded with a diagnosis of lumbago (general low back pain) and recommended non-surgical treatment.  

During the 21 February 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the examiner noted tenderness of the back and “decreased” range of motion (ROM) of the thoracolumbar spine.  At the 10 April 2008 physical therapy appointment, 5 months prior to separation, the examiner documented ROM with flexion to 50 degrees (normal 90) and combined ROM of 175 degrees (normal 240), with all planes of motion limited by pain.  At the 11 April 2008  MEB NARSUM examination, 5 months prior to separation, the CI complained of constant dull LBP rated 6-8/10 in severity, aggravated by running, jumping, impact activity, or exercise.  The examiner quoted data from earlier medical appointments in lieu of physical examination.  

At the 30 September 2008 VA Compensation and Pension (C&P) evaluation, 1 month after separation, physical examination showed tenderness and spasm of the back muscles but no guarding and a normal gait.  ROM was recorded as flexion to 50 degrees (normal 90) with combined ROM of 200 degrees (normal 240); pain was noted in all planes of motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5299-5242 (analogous to degenerative arthritis of the spine), citing flexion measures of 53 degrees with combined ROM of 173 degrees which was used for rating with consideration of Waddell signs (tests for non-physiologic sources of pain).  The VA rated the back 20%, coded 5243-5237 (intervertebral disc syndrome – lumbosacral strain), based on the C&P examination, citing limited range of 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 all examinations proximate to separation.  There was no evidence of intervertebral disc syndrome which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under that alternate VASRD formula.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the low back condition, coded 5299-5242.  

BOARD FINDINGS:  In the matter of the lower back pain, the panel recommends a disability rating of 20%, coded 5299-5242 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	
Lower Back Pain	5299-5242	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170301, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180004934, 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