RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02235
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050519

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Human Recourses Specialist, medically separated for “chronic subjective low back pain” with a disability rating of 10%.    

CI CONTENTION:  Review all conditions.  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 – 20050207	VARD - 20060502 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Subjective Low Back Pain	5299-5237	10%	Low Back Strain	5237	10%	20060206	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Subjective Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back pain condition began in December 1998 after falling.  As time progressed, the CI continued to have chronic back pain.  Magnetic resonance imaging from September 2004 showed mild diffuse spondylosis and degenerative facet disease.  There was no surgical indication.

The 21 July 2004 physical therapy clinic examination, 10 months prior to separation, noted complaints of achy, sharp pain.  Range of motion (ROM) measurements were flexion of 90, 93 and 88 degrees (normal 90) and combined ROM of 225 degrees (normal 240).  The examiner recorded the CI had a normal gait.   

The 6 January 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of chronic low back pain. Physical examination showed normal gait, strength and coordination on heel and toe walking.  ROM measurements were flexion of 90 degrees and extension of -15 degrees. There was tenderness and motor strength was 5/5 bilaterally.  

At the 6 February 2006 VA Compensation and Pension (C&P) examination, 9 months after separation, the CI reported occasional low back pain.  Physical examination showed a normal gait and posture.  Examination of the lumbosacral spine showed “normal range of motion, no pain during range of motion, normal anatomy… musculature…strength, [and] no deformities, and repetitive movements (repeated flexions) did not decrease range of motion or spine function.” 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back pain condition 10%, analogously coded 5299-5237 (lumbar spine strain), citing thoracolumbar range of motion greater than 240 degrees.  The VA also rated the low back pain condition 10%, coded 5237 (lumbar spine strain), based on the C&P examination, citing some evidence of functional loss.

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  physical therapy examination.  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 low back pain condition.  

BOARD FINDINGS:  In the matter of the low back pain 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 20170221, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180010726, 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