RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01943
BRANCH OF SERVICE:  ArmY	SEPARATION DATE:  20060729

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E7, Cryptologic Linguist, medically separated for “low back pain” with a disability rating of 0%.  

CI CONTENTION:  Review all conditions.  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 - 20060518	VARD - 20061106	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5237	0%	Degenerative Arthritis, Lumbar Spine With radiation	5242	10%	20060726	
Seasonal Allergies	Not Unfitting	Seasonal Allergies	No VA Placement	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s LBP began in 1998 after lifting a heavy rack of rifles.  An MRI dated 6 February 2004 demonstrated a minimal disc bulge at L4-5.  He received physical therapy for over 6 years without a decrease in symptoms, and was subsequently placed on a permanent profile, which did not change the back condition.  An MRI in 2005 showed prominent lordosis with L4-5 disc bulge (original report not in evidence).  

The 7 February 2006 MEB NARSUM physical medicine & rehabilitation (PMR) examination, 5 months prior to separation, noted CI complaints of LBP when he resumed full duty, went to the field, wore a ruck, practiced the practical portion of his military specialty, or performed physical training.  He could not tolerate prolonged sitting/standing, running, or sit-ups.  Physical examination showed no abnormalities or tenderness and full range of motion (ROM) with non-painful active and passive movements.  Axial loading of spine, facet loading, straight and crossed leg raise (SLR) testing (to determine nerve root irritation) and FABER tests (to determine hip pathology) were all negative.  At a chiropractic evaluation on 27 February 2006, the CI’s lumbar ROM was within normal limits.  During a physical therapy (PT) appointment on 27 March 2006, 4 months before separation, flexion was 30 degrees (normal 90), with pain, and combined ROM was 155 degrees (normal 240), after repetitive motion.  

At the 26 July 2006 VA Compensation and Pension (C&P) examination, 3 days before separation, the CI reported persistent LBP which was stiff and aching in nature, but tolerable; he used medication as needed.  Physical examination showed flexion to 90 degrees and combined ROM of 240 degrees with pain after repetition, no paravertebral muscle spasm, and negative SLR testing.  Motor strength, sensation, and reflexes were normal in the lower extremities.  A CT scan did not reveal disc pathology, but did show facet arthropathy bilaterally.  The examiner’s diagnosis was LBP with leg radiation secondary to degenerative lumbar spine osteoarthritis. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 0%, analogously coded 5299-5237 (lumbosacral strain), citing decreased ROM due to pain based on the PT study; and full, spinal ROM which was “non-painful in both active and passive modes” noted by the PMR NARSUM.  The VA rated the low back condition 10%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing pain on motion and arthritic changes of the spine.  Members noted that while the limited ROM recorded by PT met the threshold for a 40% rating, based on prior and subsequent examinations, the 30 degrees of flexion due to pain appeared to be an outlier, and could not be explained by an accident, injury, or any significant report of or treatment for pain in the time frame around the examination.  The MEB NARSUM measurements met the threshold for a 0% rating, but the VA examination, 3 days prior to separation, was more detailed and reported ROMs performed after repetitive motion.  Therefore, the panel placed greater probative value on this examination.  There was no limitation of thoracolumbar spine motion to support a 10% rating under the General Rating Formula for Diseases and Injuries of the Spine, however the PT and VA examinations noted the presence of painful motion, and thus a 10% rating was warranted.  There was no muscle spasm or guarding 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 recommends a disability rating of 10% for the LBP condition, coded analogously coded 5299-5237.  

Contended PEB Condition:  Seasonal Allergies.  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 chronic low back pain, the panel recommends a disability rating of 10%, analogously coded 5299-5237 IAW VASRD §4.71a.  In the matter of the contended seasonal allergies condition, the panel agrees it cannot recommend it for additional disability rating.  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	
Chronic Low Back Pain	5299-5237	10%	

AR20180014716, 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.