RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-02046
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070917

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

CI CONTENTION:  His back condition continues to worsen and negatively impact daily activities.  He also requested review 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 - 20070808	VARD - 20071130	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Axial Low Back Pain	5299-5237	10%	Chronic Axial Low Back Pain	5242	10%	20070908*	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	
*8 September 2007 C&P examination not in evidence

ANALYSIS SUMMARY:  

Chronic Axial Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in approximately 2001 after numerous rucksack marches.  An MRI in July 2004 showed degenerative discs with moderate central disc protrusion at L5-S1 and minimal disc bulge at L4-L5.  A repeat MRI in May 2008 showed disc herniation primarily at L5-S1 with mild joint space loss.  There was degenerative endplate change at L5-S1 and a small central disc protrusion at L4-5 (degenerative joint and disc disease).  The neurosurgery appointment noted lumbosacral flexion limited to 30 degrees (normal ~60) and painful.  The neurological examination and gait were normal and spasm absent.  Provocative testing for nerve root irritation was negative.  At the time of the neurosurgery clinic appointment on 7 June 2007, the CI reported back pain and no radicular symptoms.  The CI declined surgical treatment and requested an MEB.  Thoracolumbar range of motion (ROM) measurements performed by physical therapy (PT) on 15 June 2007 showed flexion of 15 degrees (normal 90) and combined ROM of 95 degrees (normal 240) after repetition, limited by pain.  

The 22 June 2007 MEB examination (recorded on the DD Form 2808), 3 months before separation, noted decreased lordosis, but no signs of non-organic pain, and negative provocative testing radicular symptoms.  The neurological examination was normal.  The 12 July 2007 MEB NARSUM examination, 2 months prior to separation, noted complaints of increased back pain.  Physical examination showed a normal gait and stance including toe and heel walk.  Motor, reflexes, and sensation testing were normal.  Provocative testing for nerve root irritation was negative.  

According to the 8 September 2007 VA Compensation and Pension (C&P) examination findings, 9 days before separation, the CI reported continued pain in the back that radiated to his legs.  Physical examination showed flexion of 70 degrees with pain and combined ROM of 220 degrees with painful motion.  Repetitive motion revealed an increase in pain without a reduction in ROM.  No comment was made on the gait or neurological examination.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5299-5237 (lumbar spine strain), citing ROM limited by pain and tenderness.  The VA also rated the back condition 10%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined ROM greater than 120 degrees but not greater than 235 degrees.  

The panel noted that the limitation of thoracolumbar motion recorded in the PT examination met the threshold for a 40% rating and the VA ROM measurements met the threshold for a 10% rating.  In assigning probative value to these somewhat conflicting examinations, the panel noted that the significant PT ROM limitations were not corroborated by objective findings of significant spasm or guarding.  The panel was unsure if the CI attempted thoracolumbar spine excursion to full painful limits or stopped when pain started; the latter is not an acceptable standard for a ratable measurement.  The panel did note that the CI was recorded as having a normal gait on subsequent examinations, which is not consistent with the limitation in flexion recorded in physical therapy.  The panel also considered the possibility of a flare in back pain (due to a 10 day field exercise in May) that responded to treatment, resulting in improved ROM closer to separation.  Therefore, based on all the evidence and the associated conclusions just elaborated, panel consensus was that preponderant probative value should be assigned to the VA ROM examination.  

The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) and combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the VA examination proximate to separation.  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 back condition.  

BOARD FINDINGS:  In the matter of the low 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 20170227, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR, 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