RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-01480
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20040416

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

CI CONTENTION:  No specific contention 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 - 20040205	VARD - 20040608	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5237	0%	Herniated Nucleus Pulposus L4-5	5243	10%	20040401	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Back Pain.  According to the STR and MEB narrative summary (NARSUM), the CI’s back pain condition began in May 2003 after falling during a run.  Radiographic studies showed some mild focal scoliosis of the upper to mid thoracic spine and a broad-based disc bulge with left paracentral disc herniation.  There was no surgical indication.  During the 30 October 2003 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported mid and lower back pain.  Physical examination showed pain with flexion at 80 degrees (normal 90).  The 30 October 2003 MEB physical therapy (PT) range of motion (ROM) measurements, 6 months prior to separation, recorded lumbar flexions of 55, 55 and 57 degrees and combined ROM of 210 degrees (normal 240).  The physical therapist wrote “Full - no PROM (passive ROM) done.”  
The 20 November 2003 MEB NARSUM examination, 5 months before separation, noted CI complaints of progressively worsening pain localized to the upper and lower back ranging from 1-7/10 in intensity but averaging 5/10.  Described as stabbing and cramping, with occasional sharp pain in the left buttock, the pain was exacerbated with prolonged sitting or standing and improved with heat, warm massage, and pool therapy.  The examiner documented tenderness over the spine but no gross deformities, stating that “FROM [full ROM] of the spine was noted by Physical Therapy who performed his ROM x three...” The examiner also referred to the 30 October MEB examination, noting the back was “WNL [within normal limits] with the exception of some comments on the findings of otitis externa and also with back pain with flexion and with a straight leg raise.” 

At the 1 April 2004 VA Compensation and Pension (C&P) evaluation, 2 weeks before separation, the CI reported pain ever since his fall.  Physical examination documented a normal gait and station, and ROM, in degrees, was: flexion to 90 degrees, extension to 15 (normal 30), and right and left lateral flexion to 25 degrees each (normal 30).  There was painful motion and no evidence of neurovascular deficits.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 0%, coded 5237 (lumbosacral strain), citing full ROM with tenderness.  The PEB also noted the condition existed prior to service however, with evidence of a back injury due to a fall, permanent service aggravation was warranted.  The VA rated the back condition 10%, coded 5243, (intervertebral disc syndrome), based on the C&P evaluation, identifying ROM limitations with pain.  The panel deliberated over the probative value of the disparate examinations in evidence.  Members noted that although the PT ROMs were specified as “full,” these were lumbar measurements and most certainly indicated they were not of the complete thoracolumbar spine IAW VASRD §4.46 (accurate measurement).  The PT evaluation was also further from the date of separation and an outlier to the remainder of the ROMs in the record; therefore, the panel concluded it had decreased probative value for rating at separation.  Members agreed that a 10% rating, but no higher, was justified for combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported at the C&P evaluation.  The panel also noted the NARSUM examination (and PEB) documented localized tenderness which also supported a 10% rating.  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 of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the chronic back pain condition, coded 5237.  

BOARD FINDINGS:  In the matter of the chronic back pain condition, the panel recommends a disability rating of 10%, coded 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 as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Back Pain	5237	10%	

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 t Record 

AR20180005231, 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