RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01255
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070430

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Stock Control Clerk, medically separated for “chronic back pain…” with a disability rating of 10%.  

CI CONTENTION:  No specific contention was made.  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 - 20070214	VARD - 20070824	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain…	5299-5237	10%	Degenerative Disc Disease (DDD) at L5-S1…	5243	20%	20070629	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began around March 2005 while deployed, without specific injury.  X-rays in August 2006 showed degenerative changes of the thoracolumbar spine and MRI performed in October 2006 showed DDD, with disc protrusion and an extruded component contacting the left S1 nerve root.  An orthopedic consultant did not recommend surgery.  Thoracolumbar range of motion (ROM) measurements performed by physical therapy (PT) for the MEB on 27 November 2006, 5 months prior to separation, showed flexion of 45 degrees (normal 90) and combined ROM of 180 degrees (normal 240) after repetition, all limited by pain.  On examination there was localized tenderness and guarding which resulted in an abnormal gait.  There was no spasm or abnormal spinal contour noted.  

During the 28 November 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported continued back pain limiting his ability to work in his primary military specialty.  Physical examination showed a normal gait.  There was paraspinal tenderness with ROM limited by pain with decreased flexion, extension, rotation and lateral flexion.  Straight leg raise was negative and reflexes were normal.  The 23 January 2007 MEB NARSUM examination, 3 months prior to separation, noted complaints of persistent back pain.  On examination there was no back tenderness, swelling, or gross deformity noted.  The PT ROM measurements noted above were cited.  

At the 29 June 2007 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported continued lower back pain.  Flare-ups occurred weekly and lasted for hours.  There had been no incapacitating episodes requiring physician-prescribed bedrest in the past 12 months.  Physical examination showed an abnormal, limping gait.  There was lumbar paravertebral muscle spasm.  Thoracolumbar ROM was flexion of 50 degrees and combined ROM of 175 degrees after repetitive motion, all associated with painful motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5299-5237 (lumbosacral strain), citing thoracolumbar ROM limited by pain with localized tenderness.  The VA rated the back condition 20%, coded 5243 (intervertebral disc syndrome [IVDS]), based on the C&P examination, citing forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees, or (and) the combined ROM of the thoracolumbar spine not greater than 120 degrees.  

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) and/or muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour as reported on the PT and VA examinations.  There was no documentation of IVDS 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 20% for the back condition, coded 5299-5237.  

BOARD FINDINGS:  In the matter of the back condition, the panel recommends a disability rating of 20%, coded 5299-5237 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 Back Pain	5299-5237	20%	

AR20190002406, 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.