RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01605
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050228

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Radiology Specialist, medically separated for “chronic radiating low back pain” with a disability rating of 20%.  

CI CONTENTION:  “On going back issues which have affected employment options and quality of life.  Treatment for pain NSAIDS etc. have exacerbated gastro intestinal issues.”  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 - 20041223	VARD - 20060227	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Radiating Low Back Pain (LBP)	5243	20%	Lumbosacral Degenerative Disc Disease And Stenosis	5243	20%	20050519	
Occasional Heartburn	Not Unfitting	Gastroesophageal Reflux Disease	7399-7346	0%	20050519	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic Radiating LBP.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in 2001 after physical training.  An MRI in September 2004 showed mild worsening of disks protrusion at L4-5 and L5-S1 with mild canal stenosis, and bilateral lateral recess stenosis.  However, there was no surgical indication.  During the 6 October 2004 orthopedic consult, 5 months prior to separation, the CI indicated an inability to stand for longer than 10 minutes or perform any pushups or sit-ups.  Physical examination showed a normal heel and toe walk with good balance (negative Romberg).  Provocative testing for sacroiliac pain or radiating symptoms was negative.  

The 13 October 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, showed tenderness but no spasm or visible deformity.  During the 13 October 2004 Medical Record Report examination (recorded on General Services Administration Form 275) physical examination showed range of motion (ROM) of the lumbar spine with flexion of 40 degrees (normal 90) and combined ROM of 180 degrees (normal 240) with painful motion.  At the 1 December 2004 MEB NARSUM examination, 3 months prior to separation, the CI complained of constant LBP which radiated down the left leg and was aggravated by standing more than 15 minutes, bending, lifting or impact activities.  Physical examination showed a negative straight leg raise test (but there were complaints of increased LBP).  Sensory and motor examinations were normal.  

During the 19 May 2005 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported daily back pain which increased with prolonged sitting and standing, lifting, bending or walking.  Flare-ups occurred once every two days, but the CI denied incapacitating episodes.  The CI also reported occasional pain down the left posterior thigh to the knee.  Physical examination showed a normal gait without evidence of spasms, tenderness, impaired endurance or weakness.  The ROM study showed flexion of 45 degrees and combined ROM of 175 degrees.  X-rays showed L5-S1 lordosis and L5-S1 stenosis.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 20%, coded 5243 (intervertebral disc syndrome), citing limited forward flexion of 43 degrees.  The VA also rated the back condition 20%, coded 5243, based on the C&P examination, citing forward flexion greater than 30 degrees but not greater than 60 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) as reported on the Medical Record Report and VA examinations.  While the CI may have experienced radiating pain from the back condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  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 back condition.  

Contended PEB Condition:  Occasional Heartburn.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement, and did not fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended occasional heartburn, the panel recommends no change from the PEB determination as not unfitting.  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.  

AR20190002390, XXXXXXXXXXXXXXXXXXXX

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Dear XXXXXXXXXXXXXXXXXXXX:

	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.