RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01855
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090523

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

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 - 20090209	VARD - 20090616	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5299-5237	10%	Lumbar Spine Strain…	5299-5237	10%	20090415	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Chronic Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in August 2007 during advanced individual training when she began waking up with transient lower back pain of unknown etiology.  An MRI on 27 June 2008 revealed an L4‑5 disc protrusion.  There was no surgical indication.

The 12 January 2009 MEB NARSUM examination, 4 months prior to separation, noted complaints of constant back pain aggravated by increased activity such as walking more than 1 mile, running, walking up or down stairs, lifting more than 25 pounds, carrying more than 35 pounds, sitting for more than 60 minutes or standing for more than 10 minutes.  Physical examination showed a normal gait, spinal contour and no muscle spasm or guarding.  Thoracolumbar flexion was 90 degrees (normal) and combined range of motion (ROM) was 240 degrees (normal); painful motion was elicited.

At the 15 April 2009 VA Compensation and Pension (C&P) General examination, 1 month before separation, the CI reported constant lumbar spine pain with fatigue, weakness lack of endurance and incoordination on the left side.  She also had flair ups with pain, usually 3 times per month, with each episode lasting a few hours.  Precipitating factors were bending and sitting and relief came with rest and medications.  She also complained of insomnia and missing 10 days of work over the previous 12 months.  Examination demonstrated she was unsteady, but walked without an aid and walked without antalgic gait.  Repetitive ROM with goniometer was flexion to 70 degrees and combined ROM was 210 degrees; painful motion was present.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5299-5237 (lumbosacral strain), citing satisfactory evidence of pain with consideration given to VASRD §4.10 and 4.40.  The VA also rated the back condition 10%, analogously coded 5299-5237, based on the C&P General examination, citing limitation of flexion.  The panel agreed although there was insufficient limitation of motion to support a 10% rating, a 10% rating was justified due to the presence of painful motion as recorded on the MEB NARSUM and VA examinations.  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 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 low back condition.

BOARD FINDINGS:  In the matter of the back condition 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.

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 Record 

AR20180011262, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	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.

Sincerely,					      
Enclosure