RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2017-01563
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060707

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Human Resources Information Management Specialist, medically separated for “chronic low back pain” with a disability rating of 10%.  

CI CONTENTION:  Review requested of low back pain and 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 - 20060425	VARD - 20060731	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5237	10%	Lumbosacral Strain 	5237	10%	20060523	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back condition began in March 2005 after a ruck march.  She reported low back pain with muscle spasms, and some extension to the buttocks, but no radiation down the legs.  She was diagnosed with lumbago, placed on a profile, and treated conservatively (physical therapy, back class, anti-inflammatory medications) without improvement.  Lumbar spine X-rays in January and March 2006 were normal; there was no surgical indication.  

During the 24 March 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported chronic LBP.  Physical examination showed a normal gait, lumber region tenderness, and decreased extension with painful range of motion (ROM).  Bilateral lower extremity strength and reflexes were normal. Physical therapy ROM measurements for the MEB on 28 March 2006, revealed thoracolumbar flexion to 40 degrees (normal 90) and a combined ROM of 155 degrees  (normal 240), after repetition and with all planes limited by pain.  The 5 April 2006 MEB NARSUM examination noted complaints of continuous LBP, and the inability to wear a ruck, flak vest or Kevlar helmet.  She could not run, jump, do any type of repetitive lifting movements, and was unable to stand for more than 10 minutes.  Physical findings were cited from the MEB examination.  

At the 23 May 2006 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported constant, daily back pain, weakness, stiffness, fatigue and lack of endurance of the lumbar spine.  Precipitating factors were physical activity and inclement weather, with alleviation through rest and medications.  The CI denied associated radiculopathy or history of incapacitating episodes or bed rest during the previous 12 months.  Physical examination showed lumbar and bilateral paravertebral muscles tenderness, but no muscle atrophy or abnormal posture/gait.  Straight leg raise testing was negative, and lower extremity strength and reflexes were normal.  Thoracolumbar ROM was normal, but with painful motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, analogously coded 5299-5237 (lumbar spine strain), citing thoracolumbar motion limited by pain and tenderness.  The VA also rated the low back condition 10%, coded 5237, based on the C&P examination 2 months before separation, citing lumbar spine tenderness.  Members agreed that the VA examination was the most proximate examination to separation, and therefore garnered greater probative value for rating.  Although there was insufficient limitation of motion to support a compensable rating, a 10% rating was justified for the presence of painful motion and localized tenderness.  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 evidence of intervertebral disc syndrome which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating that alternate formula.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the low back condition.  

BOARD FINDINGS:  In the matter of the chronic low back pain 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.  

AR20190004092, XXXXXXXXXXXXXXXX

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Dear XXXXXXXXXXXXXXXX:

	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.