RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01301
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060826

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Automated Logistical Specialist, medically separated for “chronic low back pain” with a disability rating of 10%.   

CI CONTENTION:  “At the time the decision to medically discharge me was not properly rendered because I was not properly evaluated, MRI was not completed to determine the severity of the injury.  Medical condition severely worsen.”  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 - 20060711	VARD - 20070830	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain 	5243	10%	Thoracolumbar Strain … Disc Disease 	5237-5242	20%	20061129	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI initially injured her back during a fall during basic training in February 2004.  In October 2004 the back pain flared up again with physical fitness testing.  Imaging (MRI) demonstrated disc disease (central herniation L5/S1 with mild thecal compression but no foraminal impingement).  Earlier STR entries documented grossly normal range of motion (ROM), but later entries during MEB proceedings reflected ROM limitations.  A pain management consultant in September 2005 (nearly a year before separation) recorded flexion to only 15 degrees (normal 90), and an entry two weeks later noted flexion to 40 degrees.  Conversely, two months after that, the 13 December 2005 MEB DD Form 2808 physical examination recorded flexion to 90 degrees with pain.  There was STR documentation of normal gait and normal spinal contour, with no contrary entries.  There was no STR documentation of incapacitating episodes.

The 17 May 2006 MEB NARSUM examination, 3 months prior to separation, documented non-specific back pain that prohibited running and multiple general soldiering requirements.  The NARSUM physical examination referenced the above DD Form 2808 examination and incorporated ROM measurements from physical therapy (PT) that were conducted on 5 May 2006.  These were flexion to 70 degrees with a combined ROM of 210 degrees (normal 240), noting painful motion and guarding without spasm.

At the 29 November 2006 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported intermittent back pain radiating to the right buttock and groin.  The examiner noted that she was employed as a cashier, but with walking limited to half a mile and standing to 45-60 minutes.  The examiner documented incapacitating episodes totaling six days over the past 12 months (minimum 10% rating under that formula requires one week).  The physical examination recorded a normal gait, a normal spinal contour, and tenderness without spasm.  Measured ROM was flexion to 55 degrees with a combined ROM of 180 degrees, specifying painful motion but no degradation with repetition.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5243 (intervertebral disc syndrome), citing “essentially normal” ROM and tenderness.  The VA rated the condition 20%, coded 5237-5242 (lumbar strain - degenerative arthritis of the spine), citing the VASRD §4.71a 20% criterion for limited flexion (“greater than 30 degrees but not greater than 60 degrees”) based on the C&P ROM evidence.  

There was no evidence for abnormal gait or spinal contour to justify a 20% rating on that basis.  There was no evidence for incapacitating episodes for a favorable rating based on that formula.  There was conflicting ROM evidence, with the service PT ROM evidence supporting a 10% rating and the C&P evidence supporting a 20% rating.  The panel deliberated the probative value of these disparate examinations, with review of the overall evidence for corroboration, and concluded that the preponderance of evidence was better aligned with the PT ROM measurements.  Other than the two examiners noting limited ROM during MEB proceedings, all of the preceding and subsequent service ROM evidence was aligned with the PT measurements.  Members agreed that the single flexion measurement by the C&P examiner was not sufficient to carry the determinant probative value for the panel’s recommendation.  The panel therefore agreed that a 10% rating, but no higher, was justified for 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 in the service PT examination.  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 of the lumbar disc condition.

BOARD FINDINGS:  In the matter of the lumbar disc 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 20170224, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180007413, 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