RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02153
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051210

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Automated Logistics Specialist, medically separated for “chronic low back pain” with a disability rating of 0%.

CI CONTENTION:  No specific contention was made.  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 - 20050909	VARD - 20060208	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5237	0%	Chronic Lower Back Pain	5299-5237	0%	20050929	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0% 	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition began in July 2002 after a motor vehicle accident and was in March 2004 after strenuous training.  Subsequent X-ray and MRI imaging was normal with only incidental transitional vertebra noted; surgery was not indicated.  Multiple STR entries documented near normal range of motion (ROM) and none indicated more significant limitation, objective radiculopathy or incapacitating episodes.  The majority of STR examiners recorded spinal tenderness, and most treatment notes documented normal gait and spinal contour.

The 6 May 2005 MEB NARSUM examination, 7 months before separation, noted constant low back pain aggravated by bending, lifting, and prolonged sitting or standing.  The provider recorded a normal gait and spinal contour, no tenderness or spasm, and normal neurologic findings; ROM was not addressed.  The 17 May 2005 MEB physical therapy evaluation showed painful flexion to 65 degrees (normal 90) and combined ROM of 200 degrees (normal 240).  

The 29 September 2005 VA Compensation and Pension (C&P) examination, 2 months before separation, documented episodes of back pain (frequency not specified) that did not “interfere with her ordinary lifting or carrying, posture or gait.”  Physical examination recorded a normal gait and spinal contour, no spinal tenderness, and normal neurologic findings.  Repetitive ROM was normal in all planes without painful motion.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the lumbar condition 0%, analogously coded 5299-5237 (lumbosacral strain), citing full [passive] flexion and no focal neurological deficit.  The VA also rated the lumbar condition 0%, also analogously coded 5299-5237, based on the C&P examination, citing a non-compensable evaluation.  Members 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 (greater than 120 degrees but not greater than 235 degrees), as recorded on the MEB physical therapy ROM examination and corroborated by the preponderance of STR evidence.  Additionally, the majority of STR examiners documented spinal tenderness which could also support a 10% rating.  Although the VA evidence supports a 0% rating IAW §4.71a, panel members agreed that this examination was an outlier.  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 of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a 10% rating for the back condition code 5237.

BOARD FINDINGS:  In the matter of the chronic low back pain condition, the panel recommends a disability rating of 10%, coded 5237 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.

The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Low Back Pain	5237	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170406, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180011604, 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. 

Sincerely,					      
Enclosure