RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02022
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080604

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E2, Information Technology Specialist, medically separated for “chronic low back pain” with a disability rating of 20%. 

CI CONTENTION:  The condition continues to worsen and negatively affect daily activities.  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 - 20080423	VARD - 20081024	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5242	20%	Chronic Lower Back Pain	5237	20%	STR	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition began insidiously in 2005, but was aggravated in January 2007 after a bad exit from an aircraft during a parachute landing fall.  A scoliosis survey showed mild lumbar levoscoliosis.  A thoracic spine MRI was normal, but lumbar spine MRI showed a bulging disc at L4-5 with mild stenosis and a herniated disc at L5-S1 affecting the S1 nerve roots.  A physical therapy note on 27 November 2007, showed the CI could forward flex to touch his ankles (at least 90 degrees). 

The 1 February 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, showed tenderness.  The CI was able to heel-to-toe walk and duck walk. During the MEB NARSUM examination 2 weeks later, the CI complained of back pain with forward flexion and extension and his pain increased with prolonged standing or sitting, but there were no radicular symptoms.  Physical examination parroted the MEB examination above. 

At the 11 March 2008 physical therapy (PT) range of motion (ROM) study, 3 months prior to separation, showed flexion after repetition of 30 degrees (normal 90) with pain from 32-39 degrees.  The examiner noted the CI’s flexion was additionally limited by 10 degrees due to pain, but indicated the CI was able to forward flex beyond the above measurements without expression of pain when donning and doffing his shoes.  The combined thoracolumbar ROM was 150 degrees (normal 240) with pain in all planes of movement.  There was no VA examination proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 20%, coded 5242 (degenerative arthritis of the spine), citing forward flexion limited to 39 degrees.  The VA also rated the back condition 20%, coded 5237 (lumbosacral strain), based on the STR, citing forward flexion limited to 39 degrees.

Although the 11 March 2008 PT ROM study showed flexion limited to 30 degrees (after rounding), which normally would warrant a 40% disability rating under the General Rating Formula for Diseases and Injuries of the Spine, the panel noted the results of this ROM evaluation may have been exaggerated and, therefore, had limited probative rating value.  The panel also noted the November 2007 PT ROM evaluation indicated the CI could forward flex and touch his ankles (approximately 90 degrees) and there was no intervening event or injury in the record to account for the CI’s profound forward flexion deterioration.  There was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula.  The panel concluded there was no compelling evidence to support a rating higher than that adjudicated by the PEB.  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 back condition.  

BOARD FINDINGS:  In the matter of the back condition and IAW VASRD §4.71a, the panel unanimously 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 20170225, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180016332 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