RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02301
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050513

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E5, Motor Transport Operator, medically separated for “chronic 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 - 20050330	VARD - 20050609	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5243	10%	Arthritis, Lumbar Spine	5243	10%	20040526	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Back Pain.  According to the service treatment record and the MEB narrative summary (NARSUM), the CI underwent right L4-L5 discectomies in November 2003 and August 2004.  At the 26 May 2004 VA Compensation and Pension (C&P) examination, 12 months before separation, the CI reported a constant aching, sharp pain in the lower spine and right leg, which was elicited by physical activity.  He also had difficulty with prolonged walking, standing and running.  Physical examination showed a normal gait, but radicular testing was positive at 75 degrees bilaterally, and there was radiation of pain on movement, as well as muscle spasm and tenderness.  Thoracolumbar range of motion (ROM) measurements showed flexion of 75 degrees (normal 90) and combined ROM of 175 degrees (normal 240); ROM was limited by pain, fatigue, weakness and lack of endurance, but not by incoordination.  

Radiographic imaging from 1 July 2004, 10 months prior to separation, showed an L4-L5 herniated nucleus pulposus and right paracentral and lateral recess impinging the right L5 nerve root.  There was also a mild, broad-based disc bulge at L3-L4 that did not affect the nerve roots.  On August 2004, lumbar spine X-rays revealed a surgical probe directed toward the narrowed L4-L5 intervertebral disc space.  

The 15 January 2005 MEB NARSUM examination, 4 months before separation, noted CI complaints of chronic low back pain and stiffness, and the inability to stand for prolonged periods, march, go up and down stairs, bend or stoop.  Physical examination revealed a normal gait and station, no tenderness, and normal upper and lower extremity strength (5/5).  Thoracolumbar ROM measurements performed by physical therapy (PT) on 12 January 2005 were referenced and showed flexion of 50 degrees and combined ROM of 145 degrees, after repetitive motion; all maneuvers were restricted by pain.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5243 (intervertebral disc syndrome (IVDS)), citing thoracolumbar ROM limited by pain, with localized tenderness.  The VA also rated the low back condition 10%, coded 5243, based on the C&P examination, citing thoracolumbar forward flexion greater than 60 degrees but not greater than 85 degrees.  Members agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees), as reported on the most proximate PT MEB evaluation.  There was no documentation of IVDS 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 recommends a disability rating of 20% for the low back condition, coded 5243.  

BOARD FINDINGS:  In the matter of the low back condition, the panel recommends a disability rating of 20%, coded 5243 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

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

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Back Pain	5243	20%	

The following documentary evidence was considered:  

Exhibit A.  DD Form 294, dated 20170328, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs  

AR20190007816, 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 to 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