RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2017-01798
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060501

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Radar Repairer, medically separated for “chronic low back pain secondary to degenerative disk disease [DDD]” 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 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 FPEB - 20060307	VARD - 20061031	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain due to DDD	5299-5243	10%	DDD Lumbar Spine	5243	20%	20060906	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20% 	

ANALYSIS SUMMARY:  

Low Back Pain due to DDD.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI suffered an onset of persistent back pain after a strain injury in 2002.  Imaging demonstrated multilevel DDD (most prominent at L4/5) without bulging or neural compromise.  Neurological examinations were normal and surgery was not recommended.  There was documentation by provider entries in the STR of grossly normal, or nonspecifically limited, range of motion (ROM), and no indication of any more significant ROM limitation.  There was documentation of both normal gait and spinal contour, and there was no STR documentation of incapacitating episodes. 

The 7 December 2005 MEB NARSUM examination, 5 months prior to separation, noted complaints of constant low back pain (denying associated neurological symptoms) rated 4/10 at baseline with occasional flares to 9/10.  Functional limitations were not elaborated, but the profile prohibited running and loadbearing.  The physical examination was deferred to the MEB physical (DD Form 2808, 11 November 2005) which indicated normal spine and neurological findings.  There were no formal thoracolumbar ROM measurements in the available STR. 
At the 6 September 2006 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported persistent back pain rated 4/10 with exacerbations to 7-8/10 by lifting and prolonged sitting, standing, or walking.  The physical examination recorded “limping favoring the left leg” (no associated radicular symptoms or other explanation for the extremity pain), tenderness, no spasm, no noted guarding, and normal neurological findings.  Measured ROM was flexion to 40 degrees (normal 90) and combined ROM of 170 degrees (normal 240), specifying painful motion.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the lumbar spine condition 10%, coded 5299-5243 (analogous to intervertebral disc syndrome), citing “full painful [ROM] with tenderness.”  The VA rated the condition 20% under code 5243, based on the C&P examination and citing the applicable VASRD §4.71a spine rating criterion for limitation of flexion (see below).  

Although the available service evidence was consistent with a rating of 10%, this was rendered speculative by the absence of measured ROM.  The only ROM evidence that was compliant with VASRD §4.46 (accurate measurement) was that from the C&P examiner, and it was temporally probative to separate.  Panel members therefore agreed that the latter should be assigned the determinant probative value as the basis for the panel’s recommendation.  The panel thus 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 VA examination.  There was no documentation of incapacitating episodes which would provide for a higher rating under that formula.  After due deliberation, considering all the evidence and mindful VASRD §4.3 (reasonable doubt), the panel recommends a 20% rating for the lumbar spine condition under code 5242 (degenerative arthritis of the spine).

BOARD FINDINGS:  In the matter of the lumbar spine condition, the panel recommends a disability rating of 20%, coded 5242 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 the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Degenerative Disc Disease, Lumbar Spine	5242	20%	

PD-2017-01798

AR20200002309, XXXXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXXX

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.