RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01941
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050529

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

CI CONTENTION:  Review requested of 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 - 20050405	VARD - 20060126	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5237	10%	Lumbar Strain	5237	0%	20051126	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back pain (LBP) began while deployed in 2003.  On 20 April 2004, he reported worsened pain after recent training, and a gradual, intermittent onset over the previous 18 months.  Spinal X-rays the same day showed minimal spurring at L5 and were otherwise unremarkable.  At an emergency room visit on 4 August 2004, the CI reported new back pain after heavy lifting in the field; X-rays the following day were normal with no fractures or subluxations.  A 31 October 2004 MRI showed a broad-based disc bulge at L5/S1 with effacement of the epidural fat and minimal encroachment upon the ventral aspect of the thecal sac, but was otherwise normal.  
The 7 January 2005 MEB NARSUM examination, 5 months prior to separation, noted CI complaints of constant dull LBP, which became sharp with twisting and bending, and radiated to his lateral hips.  The pain interfered with his sleeping on a nightly basis.  Physical examination showed flexion of 90 degrees (normal) and combined range of motion (ROM) of 240 degrees (normal), with painful motion.  The CI’s gait was normal, but the examiner noted a slightly flexed stance at about 10 degrees.  There was mild tenderness from L4-S1 and at the sacroiliac joints with mild bilateral lumbar muscle spasms.  Muscle strength and sensation were normal as were deep tendon reflexes, and straight leg testing (to determine nerve root irritation) was positive.  

At the 26 November 2005 VA Compensation and Pension (C&P) examination, 6 months after separation, the CI reported LBP that radiated into his hips but denied flare-ups or any incapacitating episodes.  Physical examination showed a normal gait and heel-toe walking without difficulty.  There was mild tenderness in the lower lumber paraspinal regions, but no mention of spinal contour, spasms, or guarding.  Thoracolumbar ROM was from 0-90 degrees with a combined ROM of 240 degrees. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5237 (lumbosacral strain), citing combined thoracolumbar ROM “greater than 240 degrees” with localized tenderness.  The VA rated the back condition 0%, also coded 5237, based on the C&P examination, citing normal ROM with no objective evidence of pain.  Although there was insufficient limitation of motion to support a 10% rating, members agreed a 10% rating was justified for the presence of painful motion, tenderness, and spasm.  The NARSUM examination noted the presence of mild muscle spasm; however, it was not 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 of 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.  

BOARD FINDINGS:  In the matter of the chronic 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.  

The following documentary evidence was considered:
	
Exhibit A.  DD Form 294, dated 20170315, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180011593, 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