RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXX	CASE: PD-2017-02315
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20091102

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

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 - 20090722	VARD - 20100510	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5237	10%	Bilateral Intervertebral Disc Syndrome L5-S1 Degenerative Disc Disease, Nerve Root Sciatic	5243	40%	20100325	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 100%	

ANALYSIS SUMMARY:

Low Back Pain. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in 2000 after repelling exercises and worsened in 2006. Medication, physical therapy (PT), traction and electrical stimulation failed to allow full function in his specialty, and orthopedics determined he was not a candidate for surgical correction. At a community care clinic visit on 6 June 2008, there was focal area of tenderness in the right lumbar paraspinous region, and forward flexion was to 120 degrees (normal 90). Radiographic studies (MRI) in July 2008 demonstrated a moderate, diffuse disc bulge at L4-L5 with moderate bilateral neural foraminal narrowing at that level.  Lumbar spine X-rays in September 2008 were normal.

The 3 July 2009 MEB NARSUM examination, 4 months before separation, noted CI complaints of daily back pain, aggravated by prolonged standing, sitting or any exertional activities, and relieved by medication and stretching exercises. Physical examination showed a slow and guarded gait with use of a cane, but no muscle spasm, tenderness or radiating pain on movement. Muscle tone, strength and spine appearance were all normal, with no evidence of atrophy or muscle twitching. Measured ROM revealed flexion to 70 degrees (normal 90) and a combined ROM of 195 degrees (normal 240), with pain. The examiner also noted that the CI’s subjective complaints far outweighed clinical findings.

At the 25 March 2010 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported severe back pain exacerbated by physical activity or lifting over 30 pounds. The pain was relieved by rest and morphine, and had not resulted in any incapacitation over the previous 12 months. Physical examination showed normal posture but an antalgic gait, caused by muscle spasm, and use of a cane. Spinal contour was preserved, although there was guarding, and musculature was normal with no limb atrophy. Thoracolumbar ROM, after repetition, reveled flexion to 30 degrees and a combined ROM of 80 degrees, with pain in all planes. Lower extremity motor function was normal, but sensation was impaired; reflexes were 2+ bilaterally. The examiner noted signs of lumbar intervertebral disc syndrome (IVDS) without bowel, bladder or erectile dysfunction, but also documented that pain seemed out of proportion to the examination. Lumbar spine X-rays performed on 25 March 2010 showed joint narrowing and L5-S1 DDD, but were otherwise remarkable.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the back condition 10%, analogously coded 5237 (lumbosacral strain), citing limitation of ROM. The VA rated the back condition 40%, coded 5243 (IVDS), based on the C&P examination, citing forward flexion of 30 degrees or less. Panel members made several observations related to the ROM measurements. At PT examinations, lumbar flexion was to 20 degrees, which converts to 50 degrees of thoracolumbar spine flexion. At the NARSUM examination, flexion was to 70 degrees, while at the VA examination, flexion was reported to be 30 degrees; however, it is unclear whether any accident or injury accounted for the ROM decrease in the 8-month interval between the two examinations. Furthermore, examiners noted that there seemed to be a mismatch between the symptoms and pain level with the clinical and imaging findings. Therefore, the panel considered the NARSUM examination, the most proximate examination before separation, to have the highest probative value, and 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). 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 IVDS which resulted in incapacitating episodes requiring physician- prescribed bed rest to warrant consideration of rating under that alternate 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 back condition.

BOARD FINDINGS: In the matter of the low 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 20170222, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record
	PD-2017-02315

AR20190012147, XXXXXXXXXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXXXXXXXXXXXX

	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

	PD-2017-02315