RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE: pd-2017-01433
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20070626

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Aircraft Powertrain Repairer, medically separated for “chronic low back pain” with a disability rating of 10%.  

CI CONTENTION:  Review of all conditions requested.  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 - 20070529	VARD - 20080505	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5241	10%	S/P L4-S1 Decompression & Fusion…	5243-5241	40%	20080404	
Hypertension	Not Unfitting	Hypertension	7101	0%		
Hypercholesterolemia		No VA Placement	
History of Fatty Liver		Fatty Liver	7399-7345	NSC	20080404	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:

Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back condition began in July 2005 after his vehicle hit a rut in the road while deployed to Iraq.  He successfully completed the deployment.  A July 2006 lumbar spine MRI showed disc bulge at L5-S1 causing moderate bilateral neural foramina impingement.  The CI underwent lumbosacral decompression and fusion surgery in March 2007.  Subsequent radiographic imaging (CT myelogram) revealed evidence of post-operative changes and surgical fusion hardware in place.  There was no evidence of nerve root impingement.  

The 14 May 2007 MEB NARSUM examination, 1 month prior to separation, noted complaints of daily low back pain aggravated with normal activity.  He also reported left foot localized numbness/tingling and weakness in both lower extremities while walking up stairs.  Physical examination showed spinal tenderness but no muscle spasm.  Goniometric-repetitive range of motion (ROM) was flexion to 70 degrees (normal 90) and combined ROM was 180 (normal 240); painful motion was present.  Gait and spinal contour were not addressed.  

During the 3 July 2007 VA Compensation and Pension (C&P) general examination, one week after separation, physical examination noted that the CI’s posture and gait lacked endurance.  He used no assistive device.  The CI walked from sitting room to examination room with a limp, slow and cautious.  Lower extremity motor strength was 5/5.  ROM was flexion to 70 degrees and combined ROM was incomplete.  Painful motion, spinal tenderness, and muscle spasm were not addressed.  During the 4 April 2008 C&P spine examination, 9 months after separation, the CI complained of constant low back pain with constant numbness in his left leg.  Physical examination showed repetitive ROM of flexion to 20 degrees and combined ROM was 75 degrees; painful motion in all planes.  Gait, spinal contour, tenderness, and muscle spasm were not addressed.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5241 (spinal fusion), citing limitation of flexion and spinal tenderness.  The VA rated the low back condition 40%, also coded 5241, based on the C&P examination 9 months after separation, citing limitation of flexion.  

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).  Although the VA examination 9 months after separation supports a 40% rating based on limitation of flexion, the panel determined that the MEB NARSUM and VA general examinations most proximate to separation reflected a 10% spinal impairment at the time of separation.  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 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 concluded there was insufficient cause to recommend a change in the PEB adjudication for the low back pain condition.

Contended PEB Conditions:  Hypertension, Hypercholesterolemia, and History of Fatty Liver.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled, implicated in the commander’s statement, nor judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the chronic low back pain 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 20170225 w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180007883, 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