RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02125
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050524

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E9, Command Sergeant Major, medically separated for “chronic subjective low 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 FPEB - 20050427	VARD - 20060124	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5238	10%	Degenerative Disk Disease, Lumbar Spine S/P Laminectomy	5242	20%	20051003	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  90%	

ANALYSIS SUMMARY:  

Chronic LBP.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI had a long history of LBP and neurogenic claudication (leg pain) symptoms.  He underwent an L3 and L4 laminectomy in May 2004, and while the claudication symptoms resolved, the mechanical LBP continued.  A medial branch block (injection) and ablation (needle inserted adjacent to the medial branch nerve and connected to radiofrequency) were performed which resolved the back pain.  The CI continued to have limitation without pain at rest, and in December 2004, he underwent a lumbar radiofrequency denervation (rhizotomy) to L2 to L5 bilaterally.

At the 21 July 2004 physical therapy examination, 10 months prior to separation, repetitive “trunk” flexion was 100 degrees (normal 90) and combined range motion (ROM) was 230 degrees (normal 240); painful motion was not addressed.  During the 20 January 2005 MEB NARSUM examination, 4 months before separation, the CI reported that he could not tolerate wearing body armor or a rucksack.  The examiner documented moderate and intermittent pain, but noted no paraspinal muscle spasm or light touch sensory deficit in either lower extremity.  The 3 February 2004 MEB addendum, 3 months prior to separation, noted complaints of constant, aching and sharp LBP, exacerbated by prolonged sitting, standing and physical activity; there was no urinary dysfunction.  An MRI showed L1 vertebral body wedging, L2-L3 grade 1 retrolisthesis, L1 to S1 degenerative disc disease and spinal stenosis from L1 to L3.  X-rays were significant for a compression fracture at L1.  The examiner noted a normal gait and coordination with heels and toes ambulation, and no spinal tenderness.  Motor strength was 5/5 bilaterally, deep tendon reflexes were 2+, and sensation was intact.  Flexion was recorded as “over 90 degrees” and extension was limited to 10 degrees due to pain.  Other ROM measurements were not provided.
A record of medical care dated 25 April 2005, 1 month prior to separation, noted CI complaints of persistent LBP rated at 4/10, mild to moderate in nature.  Physical examination showed pain-free back ROM to 15 degrees with painful ROM from “16 degrees [extension] to 95 degrees [flexion].”  Increased pain was noted with flexion to the upright position.  

At the 3 October 2005 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported back pain caused by twisting his back after catching his heel on stairs.  Symptoms included tingling and burning.  Physical examination showed motor and sensory functions, as well as reflexes within normal limits.  Lumbar flexion was to 55 degrees and combined ROM was 130 degrees, with painful motion upon repetition.

The panel directed attention to its rating recommendation based on the above evidence.  The FPEB rated the low back condition 10%, coded 5238 (spinal stenosis), citing thoracolumbar ROM of 260 degrees.  The VA rated the low back condition 20%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing limitation of flexion.  Panel members agreed that a 10% rating, but no higher, was justified for limitation of combined ROM (greater than 120 degrees but not greater than 235 degrees), as recorded on the physical therapy ROM examination and corroborated by the limited ROMs documented on the MEB addendum and record of medical care entry.  The VA ROM examination was considered an outlier, as the preponderance of STR entries do not support a 20% spine ROM rating.  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 chronic subjection back pain 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 20170307, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190007272, 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