RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02137
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070522

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

CI CONTENTION:  The condition has worsened over the years.  The CI also requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  

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 - 20070322	VARD - 20070713	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5299-5237	10%	Lumbar Spine Degenerative Disc Disease	5242	10%	20070326	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in November 1999 after falling off a light medium tactical vehicle.  On 24 October 2005 the CI reported back pain after slipping and falling one day earlier.  A neurosurgical note dated 23 November 2005 indicated an MRI showed L4-5 mild annular bulging.  A spine surgeon noted the bulging was a non-specific finding, not the cause of the CI’s back pain/radicular symptoms, but that he had lumbar spine sprain.  Physical therapy (PT) was recommended along with correction of his posture.  However, the official lumbar spine MRI demonstrated some straightening of the curvature of the spine and minimal central disc protrusion at L4-5 and L5-S1.  At a neurosurgical clinic visit on 27 February 2006 the CI was felt not to be a surgical candidate at that time and further PT was recommend along with a temporary profile.  A primary care clinic note dated 31 May 2006 indicated the CI developed low back pain (LBP) a week earlier after a physical fitness test.  Treatment consisted of a nonsteroidal anti-inflammatory drug (NSAID), tramadol (an opioid-like medication), and a P3 profile.  X-rays of the lumbar spine on 18 December 2006 were negative.  

During the 15 November 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported pain and sometime numbness in his back and legs when running.  Physical examination showed a normal gait, presumably a normal range of motion (ROM), which was labeled “NML RAM,” and normal strength.  

The 3 January 2007 PT examination revealed thoracolumbar ROM, after three repetitions with an inclinometer, of forward flexion to 35 degrees (normal 90) and combined ROM of 125 degrees (normal 240), with limitation due to pain.  The examiner indicated tenderness and guarding of the lumbar spine, an abnormal gait due to guarding, and no abnormal spinal contour.  Neurodiagnostic testing on 8 January 2007 revealed a normal EMG (electromyogram) and nerve conduction studies of both lower extremities that were negative for radiculopathy or other peripheral neuropathy.  

The 6 March 2007 MEB NARSUM examination, 2 months prior to separation, noted the complaint of chronic LBP.  Physical examination showed normal sensation, strength, gait, and heel-to-toe walking.  There was no tenderness, but there was ROM loss due to pain as reported at the PT examination on 3 January 2007.  

At a pain management center examination on 7 March 2007 examination noted the thoracic spine was free of any tenderness or deformity and the lumbar spine was tender bilaterally with no spasm or deformity noted.  Motor strength, sensation, and reflexes were normal.  Treatment consisted of Mobic (meloxicam, an NSAID) and a trial of Lorcet (hydrocodone, a narcotic, and acetaminophen, a pain reliever). 

At the 26 March 2007 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported suffering from slight bulge of L4-5 disc and mild scoliosis.  Symptoms included constant pain in his lower back that was sharp, burning and aching in nature with stiffness after walking, running or climbing stairs, and locking up of his back.  Physical examination showed gait and posture within normal limits.  There was no muscle spasm, radiating pain, or ankylosis of the lumbar spine, but there was tenderness in the lower lumbar region.  Thoracolumbar ROM was flexion of 80 degrees and combined ROM of 230 degrees, with pain noted at the end of flexion and extension.  Muscle strength was within normal limits. Thoracic spine and lumbar spine X-rays were within normal limits.  At a routine VA examination on 11 August 2007 the CI reported radicular symptoms down the right lower extremity only.  On examination there was no tenderness over the back.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5299-5237 (lumbosacral), citing ROM limited by pain, with tenderness and guarding.  The VA rated the lumbar spine degenerative disease condition 10%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing localized tenderness, objective evidence of limitation of motion due to pain and a combined ROM of 230 degrees.  

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/or combined ROM (if applicable) (greater than 120 degrees but not greater than 235 degrees), as reported on the VA examination, the most proximate and precise examination 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 evidence of intervertebral disc syndrome which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula for that condition.  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 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 20170306, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180015050, 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