RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01841
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20081105

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Financial Management Technician, medically separated for “chronic low back pain” with a disability rating of 10%.

CI CONTENTION:  The condition has worsened.  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 - 20080818	VARD - 20090330	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Chronic Low Back Pain	5243	10%	20080908	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in 2005 after heavy lifting and worsened with two pregnancies.  Serial radiographic studies were normal.  At the 15 May 2008 orthopedic examination, 6 months prior to separation, the CI reported 5/10 left lower back pain radiating into the left hip.  An MRI dated 28 April 2008 showed a small disc bulge at L5-S1 without nearby nerve compression.  On physical examination (PE) there was tenderness about the low back without spasms.  The lumbosacral spine had a normal appearance without visual deformity.  The lower spine range of motion (ROM) was normal without pain.  Provocative testing to elicit radicular symptoms was negative.  
At the 27 June 2008 physical therapy (PT) examination, 4 months prior to separation, the CI complained of left sided low back pain shooting down into the left buttock with “giving way sensation to bilateral lower extremities when running greater than 5-10 minutes.”  Her spinal ROM was described as, “thoracolumbar flex to toes, extend on hands, right side bend and left side bend to the knees.”  Spinal tenderness was present.  There was normal motor strength, sensation and reflexes, and provocative testing to elicit radicular signs was negative.  

During the 16 July 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported sacroiliac joint pain.  Her PE showed no swelling, tenderness or spasm of the back and the CI’s gait was normal.  The focused examination revealed a loss of normal lumbar lordosis with the presence of muscle spasm.  ROM testing showed decreased ROM with pain, but measurements were not provided.  Provocative testing to elicit radicular signs was negative.  The neurological examination showed normal motor strength, sensation and reflexes.  

The 18 July 2008 MEB ROM study performed by PT, 4 months prior to separation, revealed normal, but painful thoracolumbar ROM.  The 28 July 2008 MEB NARSUM examination, 3 months prior to separation, noted complaints of low back pain that was aggravated with prolonged standing or sitting.  Her PE noted spinal tenderness.  Her gait was normal as was her motor strength, reflexes and sensation.  Provocative testing to elicit radicular signs or sacroiliac pathology were negative.  The examiner referred to previous PT ROM measurements.  

At the 8 September 2008 VA Compensation and Pension (C&P) evaluation, 2 months before separation, the examiner noted that the CI could “walk briskly without any difficulties” and opined “that her physical limitation is minimal today.”  Her PE revealed “mild curvature of the lumbosacral region secondary to muscle spasms.”  Her spinal ROM noted normal flexion and near normal combined ROM of 230 degrees (normal 240).  There was no evidence of additional loss of motion due to lack of endurance, fatigability or weakness with repetitive motion.  Provocative testing to elicit radicular signs was negative.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition at 10%, coded 5237 (lumbosacral strain), citing tenderness.  The VA also rated the back condition at 10%, coded 5243 (intervertebral disc syndrome), based on the C&P examination, citing functional loss due to pain, reduced ROM and localized tenderness.  The panel first agreed that the C&P examination held more probative value than the other pre-separation examinations because it was conducted closest to the date of separation.  It was noted that muscle spasm associated with an abnormal spinal contour was present on both the MEB and C&P examinations, though the MEB examination was internally inconsistent in that regard.  However, the panel concluded that there was a sufficient basis for a 20% rating (for muscle spasm severe enough to result in an abnormal spinal contour).  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 20% for the back condition, coded 5237.

BOARD FINDINGS:  In the matter of the back condition, the panel recommends a disability rating of 20%, 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 Low Back Pain	5237	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170307, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180005425, 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