RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01206
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070328

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Power Generator Equipment Repairer, medically separated for “chronic low back pain” with a disability rating of 0%.  

CI CONTENTION:  Review requested of back pain as well as additional 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 - 20070205	VARD - 20070919	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain [LBP]	5299-5242	0%	Degenerative Disc Disease [DDD], Lumbar Spine	5242	10%	20061220	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic LBP.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back condition began in early 2005 during physical training.  On 20 September 2006, X-rays showed mild DDD at the L4-L5 level and minimal anterior spondylosis of L5; there was no surgical indication.  At the time of the chiropractic clinic appointment on 27 September 2006, 6 months prior to separation, the CI reported LBP, and the provider noted tenderness of the left iliolumbar region. The lumbosacral spine demonstrated full range of motion (ROM), with pain at the end ranges.  An MRI on 19 October 2006, 5 months before separation, revealed DDD at L4-5 with an eccentric left posterolateral disc protrusion seen indenting the thecal sac and left L5 nerve root; and DDD at L1-L2 and L5-S1 with a minimal central disc protrusion slightly indenting the thecal sac.  

At the 20 December 2006 VA Compensation and Pension (C&P) examination, 3 months prior to separation, the CI reported LBP aggravated by exercise, prolonged standing, bending and changes in weather.  Flare-ups occurred 6 times yearly and were rated at 10/10 on the pain scale.  Physical examination showed a normal gait, without use of ambulatory aids, and a normal appearing lumber spine.  Muscle strength was 5/5 and there was no pain, weakness, fatigue, palpable swelling or joint effusion.  There was no tenderness or muscle spasm noted, and straight leg raise) testing was negative.  Thoracolumbar ROM showed flexion of 85 degrees (normal 90) and combined ROM of 235 degrees (normal 240).  

The 4 January 2007 MEB NARSUM examination, 3 months before separation, noted CI complaints of severe LBP.  Physical examination showed a normal gait and toe and heel walking, and no tenderness.  Reflexes were 2+ and equal at the patellar and Achilles areas, and lower extremity strength was normal (5/5) with both flexors and extensors.  Thoracolumbar ROM showed flexion of 80 degrees and combined ROM of 230 degrees.  

On 31 January 2007, thoracolumbar ROM measurements performed by physical therapy (PT), 2 months prior to separation, showed flexion of 20 degrees and combined ROM of 115 degrees after repetition.  It was noted that the PT examiner measured the ROM with an inclinometer rather than a goniometric, which is specified by the VASRD (§4.71a, Plate V).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 0%, analogously coded 5242 (degenerative arthritis of the spine), citing ROM limited by pain.  The VA rated the low back condition 10%, coded 5242, based on the VA C&P examination, citing forward flexion limited to 85 degrees.  As stated previously, the PT examination provided ROM values using an inclinometer.  Thus, members adjudged that the NARSUM and C&P examinations provided the greatest probative value, and 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).  There was no documentation of intervertebral disc syndrome with incapacitating episodes 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 10% for the low back condition, coded 5299-5242.  

BOARD FINDINGS:  In the matter of the low back condition, the panel recommends a disability rating of 10%, analogously coded 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	
Chronic Low Back Pain	5299-5242	10%	

, 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.